Neurological manifestations of the antiphospholipid syndrome: Risk assessments and evidence-based medicine

E. Muscal, Robin L Brey

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterised by autoantibody production and vascular thrombosis or pregnancy morbidity. Autoantibodies generated against phospholipid and phospholipid-binding proteins often impair phospholipid-dependent clotting assays (lupus anticoagulants). These autoantibodies activate endothelial cells, platelets and biochemical cascades and can exist in autoimmune disorders such as lupus. Consistently positive antibodies may worsen the severity of thrombo-occlusive disease. The most common neurological manifestations of APS include stroke and transient ischaemic attacks due to arterial thromboses. Antiphospholipid antibodies may cause additional neurological impairments through both vascular and immune mechanisms. Antiaggregant or anticoagulant therapies are indicated for APS-related ischaemic strokes. Treatment regimens for asymptomatic antibody-positive patients and those with refractory disease remain controversial. There is scant literature on neurological APS manifestations in paediatric patients. Assessment of traditional cardiovascular and inherited thrombophilia risk factors is essential in patients with APS. Modifiable risk factors and valvular heart disease may worsen thrombotic and cerebrovascular outcomes. Alternative therapies such as statins, anti-malarials, angiotensin-converting enzyme inhibitors and thrombin inhibitors warrant further research.

Original languageEnglish (US)
Pages (from-to)1561-1568
Number of pages8
JournalInternational Journal of Clinical Practice
Volume61
Issue number9
DOIs
StatePublished - Sep 2007

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Antiphospholipid Syndrome
Evidence-Based Medicine
Neurologic Manifestations
Autoantibodies
Phospholipids
Blood Vessels
Thrombosis
Stroke
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Lupus Coagulation Inhibitor
Heart Valve Diseases
Antiphospholipid Antibodies
Thrombophilia
Antibodies
Transient Ischemic Attack
Antimalarials
Complementary Therapies
Angiotensin-Converting Enzyme Inhibitors
Thrombin
Anticoagulants

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Neurological manifestations of the antiphospholipid syndrome : Risk assessments and evidence-based medicine. / Muscal, E.; Brey, Robin L.

In: International Journal of Clinical Practice, Vol. 61, No. 9, 09.2007, p. 1561-1568.

Research output: Contribution to journalArticle

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