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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & IMPORTANCE This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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Hilezian F, Maarouf A, Boutiere C, Rico A, Demortiere S, Kerschen P, Sene T, Bensa-Koscher C, Giannesini C, Capron J, Mekinian A, Camdessanché JP, Androdias G, Marignier R, Collongues N, Casez O, Coclitu C, Vaillant M, Mathey G, Ciron J, Pelletier J, Audoin B. TNF-α inhibitors used as steroid-sparing maintenance monotherapy in parenchymal CNS sarcoidosis. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325665. [PMID: 34103339 PMCID: PMC8292597 DOI: 10.1136/jnnp-2020-325665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the efficacy of tumour necrosis factor-α (TNF-α) inhibitors used as steroid-sparing monotherapy in central nervous system (CNS) parenchymal sarcoidosis. METHODS The French Multiple Sclerosis and Neuroinflammation Centers retrospectively identified patients with definite or probable CNS sarcoidosis treated with TNF-α inhibitors as steroid-sparing monotherapy. Only patients with CNS parenchymal involvement demonstrated by MRI and imaging follow-up were included. The primary outcome was the minimum dose of steroids reached that was not associated with clinical or imaging worsening during a minimum of 3 months after dosing change. RESULTS Of the identified 38 patients with CNS sarcoidosis treated with TNF-α inhibitors, 23 fulfilled all criteria (13 females). Treatments were infliximab (n=22) or adalimumab (n=1) for a median (IQR) of 24 (17-40) months. At treatment initiation, the mean (SD) age was 41.5 (10.5) years and median (IQR) disease duration 22 (14-49.5) months. Overall, 60% of patients received other immunosuppressive agents before a TNF-α inhibitor. The mean (SD) minimum dose of steroids was 31.5 (33) mg before TNF-α inhibitor initiation and 6.5 (5.5) mg after (p=0.001). In all, 65% of patients achieved steroids dosing <6 mg/day; 61% showed clinical improvement, 30% stability and 9% disease worsening. Imaging revealed improvement in 74% of patients and stability in 26%. CONCLUSION TNF-α inhibitors can greatly reduce steroids dosing in patients with CNS parenchymal sarcoidosis, even refractory. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that TNF-α inhibitor used as steroid-sparing monotherapy is effective for patients with CNS parenchymal sarcoidosis.
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Affiliation(s)
- Frédéric Hilezian
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
| | - Adil Maarouf
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France, Marseille, France
| | - Clemence Boutiere
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France, Marseille, France
| | - Audrey Rico
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France, Marseille, France
| | - Sarah Demortiere
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France, Marseille, France
| | - Philippe Kerschen
- Service de Neurologie, Centre Hospitalier de Luxembourg, Luxembourg-Ville, Luxembourg
| | - Thomas Sene
- Service de Médecine Interne, Hôpital Rothschild, Paris, France
| | | | - Claire Giannesini
- Service de Neurologie, Hôpital Saint-Antoine, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Jean Capron
- Service de Neurologie, Hôpital Saint-Antoine, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Arsene Mekinian
- Sorbonne Université, Paris, France
- Service de Medecine Interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | | | - Géraldine Androdias
- Service de Neurologie, Sclérose en Plaques, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon/Bron, France
| | - Romain Marignier
- Pathologies de la myéline et neuro-inflammation, et Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Lyon/Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Collongues
- Servie de Neurologie, Hôpital Universitaire de Strasbourg, Strasbourg, France
- Centre d'investigation clinique, U1434, INSERM, Strasbourg, France
| | - Olivier Casez
- Clinique de Neurologie, Pathologies Inflammatoires du Système Nerveux, Hôpital Universitaire Grenoble Alpes, Grenoble, France
| | - Catalina Coclitu
- Clinique de Neurologie, Pathologies Inflammatoires du Système Nerveux, Hôpital Universitaire Grenoble Alpes, Grenoble, France
| | - Mathieu Vaillant
- Clinique de Neurologie, Pathologies Inflammatoires du Système Nerveux, Hôpital Universitaire Grenoble Alpes, Grenoble, France
| | - Guillaume Mathey
- Service de Neurologie, Hôpital Universitaire de Nancy, Nancy, France
- APEMAC, EA 4360, Université de Lorraine, Nancy, France
| | - Jonathan Ciron
- Service de Neurologie, CRC-SEP, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Jean Pelletier
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France, Marseille, France
| | - Bertrand Audoin
- Service de Neurologie, Hôpital de la Timone, Hôpitaux Universitaires de Marseille, Marseille, France
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France, Marseille, France
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Long-term outcomes of refractory neurosarcoidosis treated with infliximab. J Neurol 2017; 264:891-897. [PMID: 28260120 DOI: 10.1007/s00415-017-8444-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
Central nervous system localizations of sarcoidosis may be refractory to conventional treatment such as steroids and immunosuppressive drugs. Infliximab, a TNF-α antagonist chimeric antibody, has been shown to be effective for treatment of these localizations. The aim of this study was to evaluate the efficacy and safety, in particular the long-term outcomes, of the use of infliximab for the treatment of neurosarcoidosis. We retrospectively reviewed medical records of patients with neurosarcoidosis who had been treated with infliximab between 2009 and 2015. All patients had histologically proven non-caseating granulomas. Eighteen patients with histologically proven sarcoidosis were included in this study. All had neurological involvement consisting of meningeal (n = 16), cerebral (n = 10), spinal cord (n = 6), and/or optic nerve (n = 5) involvement. Sixteen patients had previously received at least one immunosuppressive drug in addition to corticosteroids, including cyclophosphamide in 11 patients. All patients received treatment with infliximab (3-7.5 mg/kg) associated with corticosteroids (n = 18), low-dose methotrexate (n = 15), azathioprine (n = 2), or mycophenolate (n = 1). Sixteen out of 18 patients improved clinically (initial median modified Rankin scale score of 3, final median score of 1; p < 0.0001). At 6 months after initiation of infliximab, six patients obtained complete remission (33%), ten attained partial remission (56%), and two had stable disease (11%). The median follow-up time was 20 months (range 6-93). Nine patients relapsed during follow-up (50%). Eight patients developed toxic side effects and seven of these side effects were infectious events. Infliximab is an efficacious treatment of refractory neurosarcoidosis. However, relapses frequently occurred during follow-up.
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Catford S, Wang YY, Wong R. Pituitary stalk lesions: systematic review and clinical guidance. Clin Endocrinol (Oxf) 2016; 85:507-21. [PMID: 26950774 DOI: 10.1111/cen.13058] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 12/15/2022]
Abstract
The spectrum of pituitary stalk (PS) pathology is vast, presenting a diagnostic challenge. Published large series of PS lesions demonstrate neoplastic conditions are most frequent, followed by inflammatory, infectious and congenital diseases. Inflammatory pathologies however, account for the majority of PS lesions in published small case series and case reports. Physicians must be familiar with the major differential diagnoses and necessary investigations. A comprehensive history and thorough clinical examination is critical. Although magnetic resonance imaging of the PS in disease is nonspecific, associated intracranial features may narrow the differential diagnosis. Initial investigations include basic pathology and computer tomography imaging of the neck, chest, abdomen and pelvis. Further investigations should be guided by the clinical context. PS biopsy should be considered when a diagnosis is regarded essential in centres where an experienced neurosurgeon is available. Treatment is dependent on the underlying disease process and may necessitate pituitary hormone replacement.
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Affiliation(s)
- Sarah Catford
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Vic., Australia.
| | - Yi Yuen Wang
- Department of Neurosurgery and Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Vic., Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Vic., Australia
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Saketkoo LA, Baughman RP. Biologic therapies in the treatment of sarcoidosis. Expert Rev Clin Immunol 2016; 12:817-25. [DOI: 10.1080/1744666x.2016.1175301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, University Medical Center Comprehensive Pulmonary Hypertension Center, Tulane University Lung Center, New Orleans, LA, USA
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Durel CA, Marignier R, Maucort-Boulch D, Iwaz J, Berthoux E, Ruivard M, André M, Le Guenno G, Pérard L, Dufour JF, Turcu A, Antoine JC, Camdessanche JP, Delboy T, Sève P. Clinical features and prognostic factors of spinal cord sarcoidosis: a multicenter observational study of 20 BIOPSY-PROVEN patients. J Neurol 2016; 263:981-990. [PMID: 27007482 DOI: 10.1007/s00415-016-8092-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
Sarcoidosis of the spinal cord is a rare disease. The aims of this study are to describe the features of spinal cord sarcoidosis (SCS) and identify prognostic markers. We analyzed 20 patients over a 20-year period in 8 French hospitals. There were 12 men (60 %), mostly Caucasian (75 %). The median ages at diagnosis of sarcoidosis and myelitis were 34.5 and 37 years, respectively. SCS revealed sarcoidosis in 12 patients (60 %). Eleven patients presented with motor deficit (55 %) and 9 had sphincter dysfunction (45 %). The median initial Edmus Grading Scale (EGS) score was 2.5. The cerebrospinal fluid (CSF) showed elevated protein level (median: 1.00 g/L, interquartile range (IQR) 0.72-1.97), low glucose level (median 2.84 mmol/L, IQR 1.42-3.45), and elevated white cell count (median 22/mm(3), IQR 6-45). The cervical and thoracic cords were most often affected (90 %). All patients received steroids and an immunosuppressive drug was added in 10 cases (50 %). After a mean follow-up of 52.1 months (range 8-43), 18 patients had partial response (90 %), 7 displayed functional impairment (35 %), and the median final EGS score was 1. Six patients experienced relapse (30 %). There was an association between the initial and the final EGS scores (p = 0.006). High CSF protein level showed a trend toward an association with relapse (p = 0.076). The spinal cord lesion was often the presenting feature of sarcoidosis. Most patients experienced clinical improvement with corticosteroids and/or immunosuppressive treatment. The long-term functional prognosis was correlated with the initial severity.
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Affiliation(s)
- Cécile-Audrey Durel
- Département de Médicine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France. .,Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.
| | - Romain Marignier
- Département de Neurologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 69500, Bron, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France.,CNRS UMR 555, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, 69100, Villeurbanne, France
| | - Jean Iwaz
- Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France.,Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France.,CNRS UMR 555, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, 69100, Villeurbanne, France
| | - Emilie Berthoux
- Département de Médicine Interne, CH Saint Luc Saint Joseph, 69007, Lyon, France
| | - Marc Ruivard
- Département de Médecine Interne, CHU de Clermont-Ferrand, CHU Estaing, 63003, Clermont-Ferrand, France
| | - Marc André
- Service de Médecine Interne, CHU Clermont-Ferrand, Hôpital Gabriel Montpied, 63003, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Département de Médecine Interne, CHU de Clermont-Ferrand, CHU Estaing, 63003, Clermont-Ferrand, France
| | - Laurent Pérard
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008, Lyon, France
| | - Jean-François Dufour
- Département de Médecine Interne, Centre hospitalier Fleyriat, 01012, Bourg-en-Bresse, France
| | - Alin Turcu
- Département de Médecine Interne et Maladies Systémiques, CHU Dijon, 21079, Dijon, France
| | - Jean-Christophe Antoine
- Département de Neurologie, CHU de Saint-Etienne, Hôpital Nord, 42055, Saint Etienne Cedex 022, France
| | | | - Thierry Delboy
- Département de Médecine Interne, CH Montluçon, 03100, Montluçon, France
| | - Pascal Sève
- Département de Médicine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004, Lyon, France.,Université de Lyon, Université Lyon 1, 69100, Villeurbanne, France
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Systemic Sarcoidosis Presenting with Headache and Stroke-Like Episodes. Case Reports Immunol 2015; 2015:619867. [PMID: 26491579 PMCID: PMC4603591 DOI: 10.1155/2015/619867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/13/2015] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disorder. Neurological manifestations as a presenting symptom are relatively rare. A 26-year-old male presented with a five-week history of headache suggestive of raised intracranial pressure. He subsequently developed transient episodes of mild right-sided hemiparesis and numbness. Magnetic resonance imaging (MRI) of brain revealed widespread inflammatory white matter lesions, an ischaemic focus in the left corona radiata, and widespread microhaemorrhages consistent with a more diffuse vasculopathy. Serum angiotensin-converting enzyme (ACE) level was normal. Lumbar puncture revealed an elevated opening pressure (36 cmH2O) and inflammatory cerebrospinal fluid (CSF). Computerised tomography (CT) of chest, abdomen, and pelvis revealed widespread lymphadenopathy and biopsy of axillary lymph nodes revealed the presence of noncaseating granulomata in keeping with systemic sarcoidosis. The patient responded well to corticosteroids. This case highlights the importance of considering sarcoidosis to be a rare but potentially treatable cause of stroke in younger patients.
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Hoyle JC, Jablonski C, Newton HB. Neurosarcoidosis: clinical review of a disorder with challenging inpatient presentations and diagnostic considerations. Neurohospitalist 2014; 4:94-101. [PMID: 24707339 PMCID: PMC3975794 DOI: 10.1177/1941874413519447] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neurosarcoidosis is frequently on the differential diagnosis for neurohospitalists. The diagnosis can be challenging due to the wide variety of clinical presentations as well as the limitations of noninvasive diagnostic testing. This article briefly touches on systemic features that may herald suspicion of this disorder and then expands in depth on the neurological clinical presentations. Common patterns of neurological presentations are reviewed and unusual presentations are also included. A discussion of noninvasive testing is undertaken, exploring dilemmas that may be encountered with sensitivity and specificity. Drawing from a broad range of clinical clues and diagnostic data, a systematic approach of pursuing a potential tissue diagnosis is then highlighted. Correctly diagnosing neurosarcoidosis is critical, as treatment with appropriate immunosuppression protocols can then be initiated. Additionally, treatment of refractory disease, the trend toward exploring targeted immunomodulation options, and other therapeutic issues are discussed.
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Affiliation(s)
- J. Chad Hoyle
- Department of Neurology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Courtney Jablonski
- Department of Internal Medicine, Wexner Medical Center and Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
- Department of Pediatrics, Wexner Medical Center and Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
| | - Herbert B. Newton
- Department of Neurology, Wexner Medical Center and James Cancer Hospital, The Ohio State University, Columbus, OH, USA
- Department of Neurosurgery, Wexner Medical Center and James Cancer Hospital, The Ohio State University, Columbus, OH, USA
- Department of Oncology, Wexner Medical Center and James Cancer Hospital, The Ohio State University, Columbus, OH, USA
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Abstract
Neurologic manifestations occur in more than 5% of sarcoidosis patients and may be the presenting feature. Neurosarcoidosis can manifest in a myriad of ways including: cranial neuropathy, aseptic meningitis, mass lesions, encephalopathy, vasculopathy, seizures, hypothalamic-pituitary disorders, hydrocephalus, myelopathy, peripheral neuropathy, and myopathy. Because its etiology is unknown, its neurological manifestations are so diverse, and its diagnosis cannot be readily confirmed by laboratory tests, neurosarcoidosis poses many clinical problems. The diagnosis of neurosarcoidosis is usually based on the identification of characteristic neurologic findings in an individual with proven systemic sarcoidosis as established by clinical, imaging, or histologic findings. Although corticosteroids are regarded as the foundation of treatment, they are not always successful and have serious side-effects. Moreover, some patients with neurosarcoidosis are refractory to conventional therapy, and approximately 5-10% die. Optimal management of patients with neurosarcoidosis benefits from an understanding of the broad clinical spectrum of neurosarcoidosis, appreciation of the ways to best confirm a diagnosis, and awareness of the full range of treatment options, including the use of alternative therapies such as immunotherapy.
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Affiliation(s)
- Allan Krumholz
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Barney J Stern
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW The aims of this article are to discuss the epidemiology, pathophysiology and clinical phenomenology of neurosarcoidosis, as well as current approaches to diagnosis and treatment. This review focuses on central nervous system (CNS) complications of sarcoidosis. RECENT FINDINGS Neurosarcoidosis is a rare disorder with diverse clinical manifestations and outcomes. It is often difficult to diagnose and even more difficult to treat. New diagnostic approaches include the use of [¹⁸F]-fluorodeoxyglucose PET to identify potential biopsy sites. Success has been reported in the treatment of steroid refractory cases with disease-modifying therapies that were originally designed to manage other chronic inflammatory conditions by neutralizing key cytokines or depleting leukocyte subsets. SUMMARY The diagnosis and management of neurosarcoidosis can be challenging. Currently, the disorder is treated with corticosteroids in combination with global immunosuppressant agents and/or immunomodulatory monoclonal antibodies, such as infliximab. The development of novel CNS penetrant drugs that are particularly effective at inhibiting granuloma formation would represent a significant therapeutic advance. Future progress will be informed by a deeper understanding of the pathways underlying the granulomatous inflammation characteristic of sarcoidosis and by an increased appreciation of how sarcoid lesions evolve in the CNS microenvironment.
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Pereira J, Anderson NE, McAuley D, Bergin P, Kilfoyle D, Fink J. Medically refractory neurosarcoidosis treated with infliximab. Intern Med J 2012; 41:354-7. [PMID: 21507165 DOI: 10.1111/j.1445-5994.2011.02457.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurosarcoidosis can worsen despite standard immunosuppressive therapy, a situation for which there is no established medical management. We present three cases of medically refractory neurosarcoidosis treated with infliximab. All three patients showed a clinical response to this treatment and side effects were limited. A summary of reported cases of neurosarcoidosis treated with infliximab is included. This case series supports a role for infliximab in the treatment of patients with medically refractory neurosarcoidosis.
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Affiliation(s)
- J Pereira
- Department of Medicine, University of Auckland Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
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Hostettler KE, Studler U, Tamm M, Brutsche MH. Long-Term Treatment with Infliximab in Patients with Sarcoidosis. Respiration 2012; 83:218-24. [PMID: 21811048 DOI: 10.1159/000328738] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022] Open
Affiliation(s)
- Katrin E Hostettler
- Clinic of Respiratory Medicine, University Hospital Basel, Basel, Switzerland.
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Callejas-Rubio JL, López-Pérez L, Ortego-Centeno N. Tumor necrosis factor-alpha inhibitor treatment for sarcoidosis. Ther Clin Risk Manag 2011; 4:1305-13. [PMID: 19337437 PMCID: PMC2643111 DOI: 10.2147/tcrm.s967] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sarcoidosis is a chronic multisystem disease of unknown etiology, characterized by noncaseating granulomatous infiltration of virtually any organ system. Treatment is often undertaken in an attempt to resolve symptoms or prevent progression to organ failure. Previous studies have suggested a prominent role for tumor necrosis factor-alpha (TNF-α) in the inflammatory process seen in sarcoidosis. TNF-α and interleukin-1 are released by alveolar macrophages in patients with active lung disease. Corticosteroids have proved to be efficacious in the treatment of sarcoidosis, possibly by suppressing the production of TNF-α and other cytokines. Three agents are currently available as specific TNF antagonists: etanercept, infliximab, and adalimumab. Although data from noncomparative trials suggest that all three have comparable therapeutic effects in rheumatoid arthritis, their effects in a granulomatous disease such as sarcoidosis are less consistent. In this review, current data on the effectiveness are summarized.
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Chintamaneni S, Patel AM, Pegram SB, Patel H, Roppelt H. Dramatic response to infliximab in refractory neurosarcoidosis. Ann Indian Acad Neurol 2011; 13:207-10. [PMID: 21085534 PMCID: PMC2981761 DOI: 10.4103/0972-2327.70874] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 05/14/2009] [Accepted: 06/26/2009] [Indexed: 11/09/2022] Open
Abstract
Sarcoidosis is a systemic disease characterized by noncaseating granulomas in the involved organs. Neurologic manifestations involving the central and/or peripheral nervous system occur in about 5% of patients. Neurosarcoidosis is often refractory to conventional treatment and therefore more effective treatment options are needed. While the etiology of the disease is still unknown, there is now a better understanding of its pathogenesis on a molecular level. It is clear that tumor necrosis factor-α (TNFα) plays a pivotal role in the development of the granulomas and it is believed to be a key cytokine involved in the pathogenesis of the disease. Taking advantage of this better understanding of disease pathogenesis, anti-TNFα agents are being increasingly used to treat refractory sarcoidosis. We report a patient with refractory neurosarcoidosis who showed dramatic improvement in the clinical and radiological manifestations following treatment with infliximab; he suffered a relapse upon discontinuation of the medication.
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Patel R, Cafardi JM, Patel N, Sami N, Cafardi JA. Tumor necrosis factor biologics beyond psoriasis in dermatology. Expert Opin Biol Ther 2011; 11:1341-59. [PMID: 21651458 DOI: 10.1517/14712598.2011.590798] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION TNF-α is a cytokine essential for immune response and its receptors has been shown to be dysregulated in a variety of diseases including psoriasis vulgaris. There are a number of TNF-α inhibitors approved for psoriasis, however there is a growing body of literature supporting their use in a wide variety of dermatological conditions. AREAS COVERED The use of biologic TNF-α antagonists in conditions for which they have not yet been approved by the FDA ('off-label' uses) and the literature that supports the most appropriate agents and conditions for use. A PubMed/MEDLINE search was performed with the keywords 'TNFα antagonist', 'biologic therapy', 'off-label' and 'unapproved'. The list of references and citing articles of the articles retrieved were also used as sources. This complete list was evaluated for inclusion, based on relevance to the proposed goal of this review. EXPERT OPINION There are a large number of conditions for which biologic antagonists of TNFα are effective, beyond those already approved by the FDA. The various agents vary in their efficacy in treatment, with infliximab consistently the most effective, particularly in granulomatous diseases. Although effectiveness varies among these conditions, biologic antagonists of TNF-α are promising for the treatment of these diseases.
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Affiliation(s)
- Raj Patel
- University of Alabama at Birmingham, Dermatology, 1530 Third Avenue South, EFH suite 414 Birmingham, AL 35294, USA
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Bargagli E, Olivieri C, Rottoli P. Cytokine modulators in the treatment of sarcoidosis. Rheumatol Int 2011; 31:1539-44. [PMID: 21644041 DOI: 10.1007/s00296-011-1969-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 05/22/2011] [Indexed: 11/30/2022]
Abstract
Sarcoidosis is a granulomatous lung disease in which several cytokines play a pivotal pathogenetic role. Steroid-resistant disease can be treated with immunosuppressive drugs, antimalarial therapies and recently with anti-TNFα agents. The use of biological agents for the treatment of sarcoidosis springs from research into the pathogenesis of the disease and also from the experience of rheumatologists with other chronic inflammatory diseases. Rituximab, golimumab and ustekinumab are cytokine modulators, useful in the treatment of immunoinflammatory disorders, for which randomized trials to evaluate safety and efficacy in sarcoidosis are not yet available. Novel anticytokine drugs administered alone or in association may offer a new approach to treatment of the disease. This review focuses on recent advances in anti-TNFα agents and cytokine modulators for the treatment of sarcoidosis and their therapeutic prospects.
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Affiliation(s)
- E Bargagli
- Respiratory Diseases Section, Department of Clinical Medicine and Immunology Sciences, Siena University, Le Scotte Hospital, Viale Bracci, 53100 Siena, Italy.
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Toussirot E, Pertuiset E. [TNFα blocking agents and sarcoidosis: an update]. Rev Med Interne 2010; 31:828-37. [PMID: 20510487 DOI: 10.1016/j.revmed.2010.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/09/2009] [Accepted: 02/06/2010] [Indexed: 11/30/2022]
Abstract
Increased production of TNFα by alveolar macrophages and involvement of TNFα in granuloma formation suggest that this cytokine is involved in the pathophysiology of sarcoidosis. The three available TNFα blocking agents have been tested in sarcoidosis refractory to corticosteroids or immunosuppressive drugs. Data are available from isolated case reports or limited series of patients treated in open label trials with favourable issue with anti-TNFα monoclonal antibodies. Two randomized placebo controlled studies evaluated the efficacy of infliximab in pulmonary and extra-pulmonary sarcoidosis, showing that infliximab improves significantly extra-pulmonary disease. There is no significant difference between infliximab and placebo in the treatment of pulmonary manifestations. Etanercept showed no efficacy for treating ocular sarcoidosis in a controlled trial and for pulmonary disease in an open label trial. Paradoxical cases of proven sarcoidosis have been reported in patients receiving anti-TNFα agents for chronic inflammatory rheumatic diseases. A literature review identified 28 cases, including 16 with etanercept, eight with infliximab and four with adalimumab. Although these cases were mainly reported with etanercept, paradoxical sarcoidosis has been reported with the three available anti-TNFα agents, suggesting a class effect. Changes in the cytokine balance may be involved in these cases of induced sarcoidosis, which must be known by the clinician.
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Affiliation(s)
- E Toussirot
- Service de rhumatologie, pôle de pathologies aiguës et chroniques, transplantation, éducation (PACTE), hôpital Minjoz, CHU, 25000 Besançon, France.
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Abstract
Neurosarcoidosis is a diagnostic consideration in diverse clinical settings. Efforts should be made to secure pathologic confirmation of systemic sarcoidosis; only rarely is central nervous system (CNS) pathologic confirmation available. CNS infection and malignancy should be reasonably excluded before making a diagnosis of CNS sarcoidosis. Corticosteroid therapy alone may not be sufficient to treat neurosarcoidosis; adjunct immunosuppressive agents are increasingly used to achieve an optimal clinical outcome.
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Luessi F, Sollors J, Müller H, Stoeter P, Sommer C, Vogt T, Birklein F, Thömke F. Infliximab in the treatment of rheumatoid meningoencephalitis. J Neurol 2009; 256:2094-6. [DOI: 10.1007/s00415-009-5286-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 07/22/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
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Varron L, Broussolle C, Candessanche JP, Marignier R, Rousset H, Ninet J, Sève P. Spinal cord sarcoidosis: report of seven cases. Eur J Neurol 2009; 16:289-96. [DOI: 10.1111/j.1468-1331.2008.02409.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To describe the effects of the anti-tumor necrosis factor neutralizing antibody, infliximab, and the antiproliferative immunosuppressant, mycophenolate mofetil, in refractory neurosarcoidosis. METHODS We treated patients with biopsy-proven sarcoidosis and CNS involvement, who had failed treatment with steroids, with infliximab (5 mg/kg on weeks 0, 2, and 6, and then every 6-8 weeks thereafter). Six out of seven patients were co-treated with mycophenolate mofetil (1,000 mg PO BID). Patients underwent a review of symptoms and complete neurologic examination every 3 months and MRI scanning before and after 3-4 infusions of infliximab. RESULTS All patients reported significant symptomatic improvement by the fourth infusion of infliximab, including relief of headache and neuropathic pain, reversal of motor, sensory, or coordination deficits, and control of seizure activity. Furthermore, infliximab therapy was universally associated with a decrease in lesion size or suppression of gadolinium enhancement as documented by MRI. A positive treatment response was attained irrespective of location or distribution of CNS involvement by sarcoidosis (dural/leptomeningeal based vs intraparenchymal; cord vs brain; single lesion vs multifocal). There were no serious adverse effects in a follow-up period spanning 6-18 months. CONCLUSIONS Combination treatment with mycophenolate mofetil and infliximab is a promising therapeutic approach for neurosarcoidosis.
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Affiliation(s)
- Michael Moravan
- Department of Neurobiology and Anatomy, University of Rochester School of Medicine and Dentistry, NY, USA
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Marnane M, Lynch T, Scott J, Stack J, Kelly PJ. Steroid-unresponsive neurosarcoidosis successfully treated with adalimumab. J Neurol 2009; 256:139-40. [DOI: 10.1007/s00415-009-0077-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 07/09/2008] [Accepted: 07/25/2008] [Indexed: 11/29/2022]
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Ritzenthaler T, Gonzalez-Martinez V, Guegen A, Tilikete C, Vighetto A. [Refractory neurosarcoidosis and infliximab: a growing experience]. Rev Neurol (Paris) 2008; 165:197-200. [PMID: 18653204 DOI: 10.1016/j.neurol.2008.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 04/25/2008] [Accepted: 06/06/2008] [Indexed: 11/18/2022]
Abstract
Neurosarcoidosis is a rare disease that can involve all the nervous system with variable clinical onset and prognosis. The initial therapeutic approach is mainly based on corticosteroids and immunosuppressive agents. Treatment of refractory forms of neurosarcoidosis is not well established and emerging immunomodulating drugs like infliximab have been recently tested. The clinical report of a new case of neurosarcoidosis responding to infliximab is followed by a review of the new therapeutic agents available for the treatment of refractory neurosarcoidosis.
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Affiliation(s)
- T Ritzenthaler
- Service de Neurologie D, Hôpital Neurologique, CHU de Lyon, 59 Boulevard Pinel, 69677 Bron Cedex, France.
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Díaz-Ley B, Guhl G, Fernández-Herrera J. Uso de fármacos biológicos en dermatosis fuera de la indicación aprobada. Primera parte: infliximab y adalimumab. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70159-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Toth C, Martin L, Morrish W, Coutts S, Parney I. Dramatic MRI improvement with refractory neurosarcoidosis treated with infliximab. Acta Neurol Scand 2007; 116:259-62. [PMID: 17824906 DOI: 10.1111/j.1600-0404.2007.00870.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurosarcoidosis is often a devastating, refractory condition without definite pharmacotherapies beyond corticosteroids. AIM To describe a case of steroid-refractory neurosarcoidosis with a marked clinical and radiological response to infliximab. METHODS We describe the case of a young female patient with biopsy-proven neurosarcoidosis leading to gait failure. She described significant corticosteroid-related side effects without clinical response to the therapy. Infliximab therapy was considered as a possible rescue medication. RESULTS Within months of starting intravenous infliximab therapy, she regained her ability to walk and magnetic resonance imaging identified significant improvements over a sustained course of infliximab therapy, including loss of enhancing nodules and loss of meningeal enhancement. CONCLUSION Mounting evidence suggests that infliximab is a valuable pharmacological agent in the management of patients with refractory and disabling neurosarcoidosis. Controlled studies of infliximab in this condition are needed.
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Affiliation(s)
- C Toth
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
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Sarcoidosis, role of tumor necrosis factor inhibitors and other biologic agents, past, present, and future concepts. Clin Dermatol 2007; 25:341-6. [PMID: 17560312 DOI: 10.1016/j.clindermatol.2007.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tumor necrosis factor is a potent cytokine involved in the inflammatory process of many diseases. Agents that block tumor necrosis factor have been used in the treatment of various immune-mediated diseases, including rheumatoid arthritis, Crohn disease, psoriatic arthritis, and ankylosing spondylitis. Sarcoidosis is an immune-mediated inflammatory disorder of unknown etiology characterized by the formation of noncaseating granulomas. Tumor necrosis factor plays a major role in the inflammatory process seen in sarcoidosis. Sarcoidosis therapies with activity against tumor necrosis factor and specific anti-tumor necrosis factor therapies have been used with variable success. The long-term safety and efficacy of such therapies are yet to be determined in well-designed clinical trials with long-term follow-up.
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Kumar G, Kang CA, Giannini C. Neurosarcoidosis presenting as a cerebellar mass. J Gen Intern Med 2007; 22:1373-6. [PMID: 17619108 PMCID: PMC2219770 DOI: 10.1007/s11606-007-0272-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 04/17/2007] [Accepted: 06/15/2007] [Indexed: 11/28/2022]
Abstract
CASE REPORT A 74-year-old farmer presented with worsening headaches, gait unsteadiness, and writing difficulties. On examination, he had a tendency to fall to the right and right-sided dysmetria and dysdiadochokinesis. Magnetic resonance imaging initially showed abnormalities in the right cerebellar hemisphere, suggestive of subacute infarct or infiltrating malignancy. Suboccipital craniotomy and biopsy revealed noncaseating granulomas suggestive of sarcoidosis. He was initially treated with steroids and later switched to Infliximab. On follow-up 5 months later, symptoms and imaging had improved. DISCUSSION Sarcoidosis affects the central nervous system in about 5% of patients. It usually manifests with cranial nerve palsies. It may rarely mimic a tumor as in this patient. Despite the dearth of controlled studies addressing neurosarcoidosis treatment, excellent responses to corticosteroids have been documented. Infliximab has been used as a steroid-sparing agent in neurosarcoidosis. We present this case of neurosarcoidosis presenting as a cerebellar mass to increase awareness of this condition.
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Affiliation(s)
- Gautam Kumar
- Department of Internal Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA.
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Abstract
Neurosarcoidosis is an uncommon disorder and requires a careful clinical evaluation to reach a diagnosis. Generally, patients with peripheral symptoms, which include paresthesias, muscle weakness, and stocking glove deficits, have a better outcome compared with those with central nervous system involvement. Patients with mass lesions or hydrocephalus tend to have more relapses and are often more resistant to routine therapy. Neurosarcoidosis often responds to glucocorticoids, usually within days or weeks of initiating therapy. Patients are usually maintained on 40 to 80 mg per day for 4 to 6 weeks, which is then tapered slowly. Alternative treatments for refractory neurosarcoidosis, or to reduce or eliminate steroids, include methotrexate, cyclophosphamide, azathioprine, cyclosporine, infliximab, chlorambucil, chloroquine, and hydroxychloroquine.
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Affiliation(s)
- Ashok V Patel
- William R. Tyor, MD Neurology Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
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Graves JE, Nunley K, Heffernan MP. Off-label uses of biologics in dermatology: Rituximab, omalizumab, infliximab, etanercept, adalimumab, efalizumab, and alefacept (Part 2 of 2). J Am Acad Dermatol 2007; 56:e55-79. [PMID: 17190618 DOI: 10.1016/j.jaad.2006.07.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 06/30/2006] [Accepted: 07/22/2006] [Indexed: 12/28/2022]
Abstract
Recently, dermatologists have witnessed a revolution in our therapeutic armamentarium with the development of several novel biologic immunomodulators. Although psoriasis remains the only condition in dermatology for which the use of biologic immunomodulators has been approved by the Food and Drug Administration, these drugs have the potential to significantly impact the treatment of several inflammatory conditions in dermatology. This article includes a review of the mechanism of action, dosing, and side-effect profile, as well as a review of the current literature on off-label uses of the CD20-positive B-cell antagonist rituximab, the IgE antagonist omalizumab, the tumor necrosis factor-alpha antagonists infliximab, etanercept, and adalimumab, and the T-cell response modifiers efalizumab and alefacept.
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Affiliation(s)
- Julia E Graves
- Division of Dermatology, Washington University, St Louis, Missouri, USA
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Díaz-Ley B, Guhl G, Fernández-Herrera J. Off-Label Use of Biologic Agents in the Treatment of Dermatosis, Part 1: Infliximab and Adalimumab. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chou RC, Henson JW, Tian D, Hedley-Whyte ET, Reginato AM. Successful treatment of rheumatoid meningitis with cyclophosphamide but not infliximab. Ann Rheum Dis 2006; 65:1114-6. [PMID: 16837495 PMCID: PMC1798234 DOI: 10.1136/ard.2005.042093] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hobson-Webb LD, Donofrio PD. Inflammatory neuropathies: an update on evaluation and treatment. Curr Rheumatol Rep 2005; 7:348-55. [PMID: 16174482 DOI: 10.1007/s11926-005-0019-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inflammatory neuropathies are a diverse group of illnesses sharing the pathologic characteristic of inflammation surrounding nerve fibers. They may be autoimmune, granulomatous, infectious, paraneoplastic, or paraproteinemic in origin. All can result in significant morbidity and rarely, death. It is critical to correctly diagnose these illnesses, as many respond well to treatment. In this paper, the diagnosis and latest developments in the treatment of the most common inflammatory neuropathies (Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, neurosarcoidosis, anti-myelin-associated glycoprotein neuropathy, Sjögren's syndrome, paraneoplastic neuronopathy, and vasculitic neuropathies) will be discussed.
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Affiliation(s)
- Lisa D Hobson-Webb
- Department of Neurology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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