Alternative title | Neurosarcoidose: orientações para o neurologista geral |
Author |
Dutra, Lívia Almeida
![]() ![]() Braga-neto, Pedro ![]() ![]() Oliveira, Ricardo Araújo ![]() ![]() Pedroso, José Luiz ![]() ![]() Abrahão, Agessandro ![]() ![]() Barsottini, Orlando Graziani Povoas ![]() ![]() |
Institution | Universidade Federal de São Paulo (UNIFESP) |
Abstract | Neurosarcoidosis (NS) more commonly occurs in the setting of systemic disease. The diagnosis is based on a clinical history suggestive of NS, presence of noncaseating granulomas, and supportive evidence of sarcoid pathology, laboratory, and imaging studies. NS could involve any part of the nervous system and often demands high doses of steroids for symptom control. It presents low response to isolated steroids administration and frequently requires immunosuppressive agents. In NS, lymphocytes are polarized toward an excessive Th1 response, leading to overproduction of TNF-alpha and INF-gama, as well as lL-2 and IL-15. Infliximab, a chimeric monoclonal antibody that neutralizes the biological activity of TNF-alpha, is a new option in the NS treatment. We revised pathophysiology, clinical manifestations, diagnostic work up, and treatment of NS as guidance for the general neurologist. A neurosarcoidose (NS) ocorre frequentemente no contexto de doença sistêmica. O diagnóstico é baseado na história clínica sugestiva de NS, presença de granulomas não-caseosos e achados anatomopatológicos, laboratoriais e radiológicos de sarcoidose. A NS causa manifestações neurológicas variadas, que apresentam, em geral, baixa resposta ao corticoide isoladamente e, portanto, necessitam uso de imunossupressores. Na NS, os linfócitos estão polarizados para resposta Th1 excessiva, levando à produção aumentada de TNF-alfa e IFN-gama, assim como IL-2 e IL-15. Infliximabe, um anticorpo monoclonal quimérico que neutraliza a atividade biológica do TNF-alfa, é uma nova opção no tratamento da NS. Revisou-se a fisiopatologia, as manifestações clínicas, o diagnóstico e o tratamento da NS para orientar neurologistas gerais. |
Keywords |
sarcoidosis
neurosarcoidosis methotrexate azathioprine cyclophosphamide infliximab sarcoidose neurosarcoidose metotrexato azatioprina ciclofosfamida infliximabe |
Language | English |
Date | 2012-04-01 |
Published in | Arquivos de Neuro-Psiquiatria. Academia Brasileira de Neurologia - ABNEURO, v. 70, n. 4, p. 293-299, 2012. |
ISSN | 0004-282X (Sherpa/Romeo, impact factor) |
Publisher | Academia Brasileira de Neurologia - ABNEURO |
Extent | 293-299 |
Origin |
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Access rights | Open access ![]() |
Type | Article |
Web of Science ID | WOS:000302889200014 |
SciELO ID | S0004-282X2012000400014 (statistics in SciELO) |
URI | http://repositorio.unifesp.br/handle/11600/7045 |
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