Antiphospholipid syndrome, according to the generally accepted definition, is an autoimmune disease characterized by recurrent arterial and/or venous thrombosis and/or fetal loss occurring due to the presence of antiphospholipid antibodies. However, patients with antiphospholipid syndrome often have various non-thrombotic manifestations, including those indicating nervous system involvement. Their spectrum is quite wide and includes epilepsy, migraine, chorea, a syndrome mimicing multiple sclerosis, opticomyelitis-associated disorders, transverse myelitis, cognitive dysfunction, etc. Antiphospholipid syndrome is far less common in children than in adults, however, taking into account the significant impact on a child’s quality of life and its social prognosis, it is an important problem of pediatrics. It is known that the hemostatic system in different periods of a child’s life is characterized by a number of significant features, thus determining different rates of development of antiphospholipid syndrome thrombotic manifestations with peaks in the neonatal period and in adolescence. However, the prevalence and clinical features of various non-thrombotic neuropsychiatric manifestations in children have not been thus far adequately addressed. The issue of their possible inclusion in the antiphospholipid syndrome
classification criteria still remains unresolved, there are no agreed recommendations for treatment. Recommendations for the treatment of non-thrombotic manifestations of antiphospholipid syndrome are mainly based on the results of a few non-randomized retrospective studies and descriptions of individual cases, therefore they are quite subjective. Autoimmunity and inflammation are believed to have a large role in the development of non-thrombotic neurological disorders but the contribution of ischemia is not excluded. In view of this, immunosuppressive drugs, glucocorticoids, as well as anticoagulants and antiplatelets are used for treatment, in addition to symptomatic medications (anticonvulsants, psychotropic drugs, analgesics, etc.).
This review summarizes current data on the pathogenesis, clinical manifestations and treatment of neuropsychiatric manifestations of antiphospholipid syndrome with an emphasis on their features in children.
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