Treatment of neurosarcoidosis--innovations and challenges.

INTRODUCTION: Sarcoidosis affects the central nervous system more frequently than it used to be believed. While the cranial nerves are most frequently affected, neurosarcoidosis can involve other nervous system tissues as well. TREATMENT OF NEUROSARCOIDOSIS: Although a lot of drugs have proved useful in treating neurosarcoidosis, corticosteroids are still the gold standard in treatment of these patients. Therapeutic protocols differ regarding the dose of these drugs. Symptomatic neurosarcoidosis should always be treated with pulse corticosteroid therapy. People with diabetes, high blood pressure, osteoporosis and tuberculosis should be carefully monitored, as they are prone to complications associated with treatment with corticosteroids. In cases when treatment with corticosteroids does not show the desired results or therapy is discontinued due to the development of side effects, there are other pharmacologic options, such as methotrexate, mycophenolate mofetil, cyclophosphamide, chloroquine, azathioprine, thalidomide, and infliximab. It should be noted that the treatment response to the above mentioned regimens, except for infliximab, is relatively slow compared to corticosteroids; therefore, corticosteroids should be taken into account in all states and particularly in the acute phase of the disease. CONCLUSION: It is the existence of different forms of the disease, lack of local diagnostic criteria and different and non standardized therapy that makes the treatment of this disease difficult. Despite advances in pharmacotherapy and radiological diagnosis, it is necessary to develop better diagnostic strategies in order to set the optimal therapeutic approach.

Diagnosis of neurosarcoidosis--necessity of biopsy.

INTRODUCTION: Sarcoidosis can affect any part of the central nervous system presenting with an extremely diverse clinical picture. Clinical presentations actually depend on the localization ofgranulomas in the central nervous system. Making diagnosis according to the localization and the clinical variations is often a clinical challenge. DIAGNOSIS OF NEUROSARCOIDOSIS: Diagnosis is based on the clinical picture, clinical and radiological findings (magnetic resonance imaging with contrast endocranium), laboratory findings (angio-tenzin-converting enzyme and chitotriosidase in cerebrospinal fluid); however, it is necessary first to exclude all other possible causes of granulomatous inflammation. Recent studies in patients with neurosarcoidosis show a high value of at least one marker of the disease. The safest way and the gold standard in diagnosing this disease would be histopathological confirmation, which is rarely performed due to its invasiveness. CONCLUSION: New diagnostic methods will contribute to better methods of bypassing invasive procedures, and they will significantly facilitate the diagnosis of neurosarcoidosis, which is a real challenge even for experienced clinicians who deal with this disease.

Radiological presentation of neurosarcoidosis.

INTRODUCTION: In diagnostics of neurosarcoidosis, radiological diagnostic procedures are available, non-invasive and they contribute significantly to the diagnosis of this disease. The aim of this paper is to present a brief overview of the radiological diagnostic methods, their application, and their importance in daily clinical work with these patients. RADIOLOGICAL PRESENTATION OF NEUROSARCOIDOSIS: Magnetic resonance is the method of choice in diagnostics of this disease. Computed tomography can also be helpful in patients with contraindications for magnetic resonance, although it is less precise in assessing the involvement of the periventricular white matter, hypothalamus, and cranial nerves. The number of lesions and the degree of involvement of the parenchyma and leptomeninges are better seen by magnetic resonance than by computed tomography scan. It is important to note that the magnetic resonance imaging may be normal in patients with neurosarcoidosis, especially in patients with cranial neuropathy, or in patients treated with corticosteroids. There is a number of variability in the occurrence of neurosarcoidosis on radiological images. CONCLUSION: Radiological procedures are on the very top of diagnostic pyramid of this disease due to their availability, non-invasiveness, and precision.

What is the future of methotrexate in sarcoidosis? A study and review.

The decision for treating patients with chronic systemic sarcoidosis is often difficult and controversial. Methotrexate (MTX) has been used to treat patients with chronic forms of the disease for years, although prospective, randomized studies assessing the efficacy and toxicity of this agent are lacking. This is the follow-up study of 91 patients with the chronic form of pulmonary and extrapulmonary sarcoidosis who were treated with MTX. All patients experienced treatment with corticosteroids before they were administered MTX. Most of the patients treated with MTX showed improvement on chest radiographs, lung function tests, and extrapulmonary signs of the disease 6 months after the treatment began. No side effects that would cause the patients to discontinue the treatment were observed.