No Consensus Treatment for Neurosarcoidosis

In the absence of a guideline and extensive data, clinicians must rely on clinical experience and expert opinion.

Neurology Reviews. 2018 March;26(3):21

February 28, 2018|Neurology

For most of his patients, this regimen is sufficient, although some patients require doses of 8 mg/kg, and others need an infusion at that level every four to six weeks. These regimens are often effective. While such patients are usually on concurrent prednisone, a recent trend is to use concurrent methotrexate to prevent reactions to infliximab. A few patients who receive infliximab plus methotrexate tend to tolerate the combination fairly well, said Dr. Eckstein.

Researchers have studied one nonpharmacologic treatment for neurosarcoidosis: radiotherapy. Dr. Eckstein cited recent case reports that examined low-dose, whole-brain radiation in refractory cases. “This is not something I have any hands-on experience with,” he said. “Most of my patients have responded to one of the other steroid-sparing agents [listed] when they’re refractory. But this is something that may be looked at more in the next several years. If there are people who have a very focal kind of encephalitic nodules, they can [undergo] fractional or focal radiotherapy.”

—Fred Balzac

No Consensus Treatment for Neurosarcoidosis

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