NEUROSARCOIDOSIS, a rare and complex inflammatory disorder of the nervous system, presents unique challenges for diagnosis and treatment due to its variability and limited research. In a new study, experts from across the United States have issued new consensus recommendations to guide healthcare professionals in managing this elusive condition.
Using a Delphi survey approach, 32 neuroimmunologists and other specialists provided critical input on evaluating, diagnosing, treating, and monitoring neurosarcoidosis. The study emphasized the importance of tailoring treatment plans to the specific phenotype and severity of the disease, especially during acute relapses and maintenance phases.
Key recommendations include prioritizing TNF-α inhibitors as first-line agents for patients with severe forms of the disease or those with poor prognoses. The experts also advocated for the integration of neuroimaging into ongoing clinical monitoring to assess treatment response.
However, the study highlighted several unresolved areas in neurosarcoidosis management. No consensus was reached regarding optimal dosing and duration of immunosuppressants or strategies for managing peripheral nervous system involvement, underscoring the need for further research.
Despite these gaps, the consensus recommendations offer valuable guidance for clinicians, providing a structured framework to improve care for neurosarcoidosis patients and paving the way for future studies. With only a small pool of randomized controlled trials available, this expert-driven guidance is a significant step forward in addressing the diagnostic and therapeutic uncertainties of the disease.
As neurosarcoidosis remains a rare condition with diverse presentations, these recommendations aim to support physicians in making informed, evidence-based decisions, while highlighting areas where further investigation is needed.
Reference: Manzano GS et al. Consensus Recommendations for the Management of Neurosarcoidosis. Neurol Clin Pract. 2025;15(2).
Anaya Malik | AMJ
