Peripheral neuropathy in pediatric systemic lupus erythematosus

Peripheral neuropathy in pediatric systemic lupus erythematosus To the Editor: I read with interest the report by Harel and colleagues, ‘Peripheral neuropathy in pediatric systemic lupus erythematosus’. [1] This report is only the second description of mononeuritis multiplex associated with childhood SLE, [2] and is hence a significant contribution to the literature on neurologic complications of the pediatric vasculitides. The report is however somewhat unclear on a number of points, clarification of which would be much appreciated. Firstly, with respect to the clinical classification of these patients, it is stated that patients 1 and 4 were felt to have mononeuritis multiplex, and patients 1-4 predominantly sensory polyneuropathies. Patient 2, however is said to have had bilateral peroneal neuropathies and (in Table 1) described as having had bilateral sural and left median neuropathies. It is unclear why this child was not felt to warrant the diagnosis of mononeuritis multiplex. Similarly, the diagnosis of asymmetric sensorimotor polyneuropathy is difficult to justify in patients with a concurrent diagnosis of mononeuritis multiplex. Few details are provided regarding the electrodiagnostic evaluations of these patients. Clarification of nerve conduction studies and electromyographic findings in patients 1, 2 and 4 would be of value. Finally, in all cases development of neuropathy was said to have occurred in concert with an increase in systemic activity of SLE. Two patients are said to have had a significant, and two a partial, response to immunosuppressant therapy. Was improvement of neuropathic symptoms concomitant with resolution of the systemic disease flare? Were anticardiolipin antibodies followed serially in these patients? If so, can the authors comment on whether serial antiphospholipid antibody determinations may be useful in following disease activity in such cases?

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Further data on these points would be of considerable value. Such cases are so uncommon that they warrant detailed description. Monique Ryan, MB BS, M Med Children’s Hospital Boston, MA References [1] Hatel L, Mukamel M, Brik R, Blau H, Straussberg R. Peripheral neuropathy in pediatric systemic lupus erythematosus. Pediatr Neurol 2002;27:53-56. [2] Evans OB. Polyneuropathy in childhood. Pediatrics 1979;64:96105.

To the Editor: In reply to your letter of August 16, 2002, we wish to comment on Dr. Ryan’s remarks. Patient 2 was not felt to have had the diagnosis of mononeuritis multiplex because the events were dispersed throughout a lengthy period of time. The improvement of neuropathic symptoms was concomitant with resolution of the systemic disease flare-only in Patient 1. Patients 2, 3 and 4 had ongoing disease activity despite neurologic improvement. The last point is that anticardiolipin antibodies were not followed serially (usually we check the titers at diagnosis, 3 months later and then annually). Therefore, we cannot comment on whether serial antiphospholipid antibody determination can be helpful in following the disease activity. Liora Harel, MD Rachel Straussberg, MD Schneider Children’s Medical Center of Israel Tel Aviv University Tel Aviv, Israel

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