THERAPEUTIC CONSIDERATIONS IN PATIENTS WITH REFRACTORY NEUROSARCOIDOSIS

Objective: To assess the effectiveness of alternative treatments for p atients with refractory neurosarcoidosis. Design: Nonrandomized, retro spective patient survey. Setting: Multicenter, involving patients care d for by their primary physicians and neurologists, and referred for m anagement advice to a neurology consultant. Interventions: Patients we re treated with corticosteroids and alternative treatments, including azathioprine, cyclosporine, cyclophosphamide, chlorambucil, methotrexa te, and radiation therapy. Results: Prednisone dosage was successfully tapered to 10 to 20 mg/d without worsening symptoms in 10 (38%) of th e 26 patients studied. Six (23%) patients had improved conditions whil e receiving alternative medication and nine (35%) patients' conditions remained stable with no further progression of their symptoms. Radiot herapy was beneficial for one of three patients. Four (15%) patients d id not respond to alternative treatment and died of worsening symptoms or infection. Adverse effects of the alternate medications resolved o n discontinuing treatment with the offending agent. Conclusion: Altern ative treatment is an effective adjunct to corticosteroid therapy for some patients with refractory neurosarcoidosis. Clinical deterioration may occur despite combined therapy. Choice of alternative therapy sho uld be determined, in part, by its potential adverse effects.