PURPOSE: In this study we show the benefits of methotrexate in treating patients with neurosarcoidosis.
METHODS: In the Institute of Pulmonary Diseases - Belgrade (Serbia), methotrexate has been used in the treatment of sarcoidosis since 1997. During past 8 years out of 635 patients with biopsy positive pulmonary and extra pulmonary sarcoidosis, 150 (24%) received methotrexate or are still under this treatment. Out of this group 20 patients with neurosarcoidosis were treated with methotrexate combining the immunnesupressive effects of this cytotoxic drug with prednislone The patients with neurosarcoidosis had different clinical and neurological manifestations; ( seizures, facial nerve palsy, oculomotrial involvement,meningeal involvement, multifocalQmass lesionW like findings, the involvement of hyphophisis, and hidrocephalus.).They were all treated with high doses of prednisolone, given in the i.v infusion at the beginning of the treatement, than tappering, with methotrexate introduced in the treatement when the steroid treatment was tappered at approximately 60- 40 mg of prednisolone daily.
RESULTS: Six months after the initiation of methotrexate all symptoms and signs of extra pulmonary disease were improved. Endocranial NMR findings were improved as well. 19 patients one year from the beginning of the treatment came to the morbostatic doses of prednisolone 5-10mg daily or alternatively, with methotrexate at about 5-10mg orally- weekly. 1 patient did not improve with this treatement. He is still on high doses of prednislone to control the neurosarcoidosis (adenohypophiseal involvement). No signs of the possible toxicity were noticed during the follow up period.
CONCLUSION: There is no general conclusion on this topic; every patient has a unique story, but methotrexate is the subject of each one.
CLINICAL IMPLICATIONS: Methotrexate is recommended in the treatment of patients with neurosarcoidosis.
DISCLOSURE: Violeta Vucinic, None.