The Antiphospholipid Syndrome as a Neurological Disease

Objectives

To examine currently known and additional potential neurological manifestations of the antiphospholipid syndrome (APS) and to discuss current and experimental therapeutic options in light of the present knowledge of the disease mechanism.

Methods

The PubMed database was searched for articles published between the years 1980 and 2008 for keywords referring to APS and several neurological conditions. Relevant English language articles were reviewed.

Results

APS is characterized by diverse neurological manifestations. These include cerebral ischemic events, epilepsy, dementia, cognitive deficits, headaches, psychiatric disorders, chorea, multiple sclerosis-like, transverse myelitis, and ocular symptoms. Some of the symptoms can be associated with ischemia; however, other mechanisms that could lead to similar outcomes have been described, such as direct binding of antiphospholipid antibodies to neural tissue. Current treatment guidelines concern cerebrovascular events only. We propose several different therapeutic options related to the autoimmune nature of the syndrome.

Conclusion

Neurological manifestations in APS are diverse and may be confused with other neurologic syndromes. This information is important for the proper diagnosis and management of patients. Experimental therapeutic alternatives expand the treatment options for patients and physicians.

Keywords: APS, antiphospholipid antibodies, migraines, seizures, cerebrovascular accidents