Neurological symptoms, including paralysis, experienced by Sjögren’s syndrome patients may not be caused by the disease but rather by mental disorders for which psychotherapy may be a better treatment option, a case report suggests.
The study, “Systemic Lupus Erythematosus and Sjögren’s Syndrome Complicated by Conversion Disorder: a Case Report,” was published in The Kurume Medical Journal.
It describes the case of a 14-year old Japanese girl, admitted to the hospital due to low platelet counts associated with an upper respiratory infection.
Based on an initial evaluation of symptoms and laboratory tests, the girl was diagnosed with Sjögren’s syndrome, showing impaired salivary secretion, and systemic lupus erythematosus, testing positive for antinuclear antibodies and exhibiting a “butterfly” rash.
But after she started corticosteroid therapy with prednisolone, she began to develop unexplainable neurological symptoms: weakness and paralysis in all four limbs and increased tendon reflexes.
She also experienced hypersensitivity to both temperature and touch at various points on her body. However, her blood, brain, and spinal cord examinations revealed no abnormalities.
Among the neurological signs of Sjögren’s syndrome, involvement of the peripheral nervous system, or the nerves that connect limbs and organs to the brain, is well-known, with a prevalence of up to 20 percent.
The disease is associated with various types of neuropathy, a malfunction of peripheral nerves, but the girl’s symptoms and examinations ruled out all of them.
Treatment with methylprednisolone pulse therapy (intermittent high doses) or intravenous immunoglobulin (IVIG), both used for the management of Sjögren’s neurological symptoms, did not completely heal the girl’s paralysis.
Given the patient’s lack of response to medication, the doctors reasoned that her neurological symptoms were not caused by Sjögren’s or lupus but rather by a psychiatric disorder.
They diagnosed her with a condition called conversion disorder — a group of illnesses marked by neurological symptoms that cannot be explained by any known neurological disease or other medical condition.
She started psychotherapy treatment 85 days after her first neurological symptoms appeared. Gradually, she began to recover her movements, and one month after leaving the hospital, she had regained full mobility in her limbs.
In the early stages, it can be difficult to determine the cause of neurological symptoms accompanying Sjögren’s syndrome and lupus, and it is often necessary to provide two lines of treatment — one for a neurological disorder and another for a mental disorder — the researchers said.
“However, when a mental disorder is suspected, treatment for neurological disorder can be minimized with early psychotherapeutic intervention,” they wrote.
“It is of great importance to determine whether paralysis in all four limbs is caused by a neurological or mental disorder because the former urgently requires an intensive intervention, such as methylprednisolone pulse therapy or IVIG therapy, whereas psychotherapy and/or antidepressant drug therapy are recommended for psychiatric manifestations,“ they concluded.