Neurosarcoidosis: guidance for the general neurologist

Neurosarcoidosis: guidance for the general neurologist

Alternative title Neurosarcoidose: orientações para o neurologista geral
Author Dutra, Lívia Almeida Autor UNIFESP Google Scholar
Braga-neto, Pedro Autor UNIFESP Google Scholar
Oliveira, Ricardo Araújo Autor UNIFESP Google Scholar
Pedroso, José Luiz Autor UNIFESP Google Scholar
Abrahão, Agessandro Autor UNIFESP Google Scholar
Barsottini, Orlando Graziani Povoas Autor UNIFESP Google Scholar
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
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
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000302889200014
SciELO ID S0004-282X2012000400014 (statistics in SciELO)

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