Kuroda Hiroshi
Department of Neurology, Tohoku University Graduate School of Medicine.
Brain Nerve. 2022 May;74(5):449-454. doi: 10.11477/mf.1416202063.
Sarcoidosis is a systemic non-caseating granulomatous disease of unknown origin, and involvement of the nervous system may result in irreversible neurological deficits. Corticosteroids (CSs) are commonly used as first-line agents for neurosarcoidosis. In steroid-refractory patients, immunosuppressants (ISs) have been used as second-line agents, and tumor necrosis factor-alpha (TNF-alpha) inhibitors as third-line agents. However, evidence regarding the treatment of steroid-refractory neurosarcoidosis is scarce, and treatment strategies for such patients have not been established. In this article, we review the evidence regarding treatments for neurosarcoidosis and strategies for refractory patients. We also discuss the practical uses of CS, IS, and TNF-α inhibitors, providing specific cases treated with such agents.
结节病是一种病因不明的全身性非干酪样肉芽肿性疾病，神经系统受累可能导致不可逆的神经功能缺损。皮质类固醇（CSs）通常用作神经结节病的一线药物。对于对类固醇难治的患者，免疫抑制剂（ISs）已用作二线药物，肿瘤坏死因子-α（TNF-α）抑制剂用作三线药物。然而，关于类固醇难治性神经结节病治疗的证据很少，此类患者的治疗策略尚未确立。在本文中，我们回顾了关于神经结节病治疗的证据以及难治性患者的治疗策略。我们还讨论了CS、IS和TNF-α抑制剂的实际应用，并提供了使用这些药物治疗的具体病例。
