Clinical manifestations and therapeutic approach in neurosarcoidosis.

Neurological impairment is a frequent cause of morbidity and mortality in p atients with sarcoidosis. The aim of this study was to evaluate the clinica l manifestations of the disease, the response to corticosteroids and altern ative treatments. During a 5 year period, diagnosis of neurosarcoidosis was performed in 40 patients. We retrospectively analyzed clinical, laboratory data and response to treatments. Mean age was 41.3 years (range 17-72), Me an time of follow-up was 46 months. Neurologic signs were the first symptom in 50p.100 of cases and an isolated manifestation in 12.5p.100. Central ne rvous system impairment was seen in 60.7p.100, meningitis in 27p.100. Other clinical manifestations were cranial nerve palsies (27p.100), peripheral n europathy (33p.100), myopathy (16p.100). Eighty percent of the patients wer e treated by corticosteroids. Because of a lack of efficacy 40p.100 of pati ent required alternative treatment (including methotrexate, cyclophosphamid e, azathioprin, cyclosporin). Complete recovery was observed in only 27.5p. 100 of cases confirming the severity of neurosarcoidosis. Forty percent of patients were clinically stable and 10p.100 worsened. No patient died. This study confirms that intensive initial treatment is often necessary to prev ent irreversible lesions. Alternative treatment should be rapidly initiated in resistant forms.