Central Nervous System Sarcoidosis: A National-Based registry study

Main Article Content

Yazan Al-Zamer https://orcid.org/0000-0002-4836-3447
Sami Al-Horani
Marah Akhdar https://orcid.org/0000-0003-2947-0818
Ghaydah Majali https://orcid.org/0000-0002-9711-7197
Hamza Alzghoul https://orcid.org/0000-0003-3123-2659
Moustafa Younis
Pouya Ameli
Bashar Alzghoul

Keywords

Sarcoidosis, Neuro-sarcoidosis, Central Nervous System, Registry

Abstract

Background and aim: Sarcoidosis of the central nervous system (CNS) often presents deleterious effects on affected patients. Data and available literature discussing the diagnosis and treatment of this condition are scarce and inconsistent. In this study, we aim to shed light on demographics, management, diagnostics, and clinical complications of CNS sarcoidosis patients within the United States (US) based on a nation-wide registry questionnaire. Methods: Our retrospective study was conducted based on a national registry investigating 3,835 respondents to the Foundation for Sarcoidosis Research Sarcoidosis Advanced Registry for Cures Questionnaire (FSR-SARC). This national registry data was collected during the period of June 2014 to August 2019. We performed propensity score matching, summary, univariate, and multivariate analyses to establish a comparison between the presence and absence of central nervous system sarcoidosis. Results: We identified a total of 420/3634 (11.55%) patients having CNS sarcoidosis; 296 (70.5%) were females, 307 (73.1%) were Caucasian and 81 (19.3%) were African American. The mean (±SD) age at diagnosis of CNS sarcoidosis was 43.3 (±12) years old. Multiorgan involvement (≥3 organs) was present in 318/420 (75.7%) patients. Brain magnetic resonance imaging was the most common ancillary diagnostic modality used and reported to be abnormal 251/328 (76.5%). Corticosteroids were the most used treatment by CNS sarcoidosis patients 206/420 (49.0%) followed by cytotoxic agents 180/420 (42.9%). Conclusions: CNS sarcoidosis prevalence in our cohort was similar to what has been described previously. The most prevalent imaging modality used was cranial MRI. Corticosteroids were the most used medications. Lastly, CNS sarcoidosis showed a propensity to cause several clinical complications such as chronic pain syndrome and disability.

Abstract 179 | PDF Downloads 133

References

1. Alzghoul BN, Zayed Y, Obeidat A, et al. Clinical Characteristics of Sarcoidosis Patients with Self-Reported Lymphoma: A US Nationwide Registry Study. Lung 2021;199(6):611–618. doi: 10.1007/s00408-021-00485-z
2. Thomas KW. Sarcoidosis. JAMA 2003;289(24):3300. doi: 10.1001/jama.289.24.3300.
3. Nozaki K, Judson MA. Neurosarcoidosis. Curr Treat Options Neurol 2013;15(4):492–504. doi: 10.1007/s11940-013-0242-9.
4. Segal BM. Neurosarcoidosis. Curr Opin Neurol 2013;26(3):307–313. doi: 10.1097/WCO.0b013e3283608459.
5. Hoitsma E, Faber CG, Drent M, Sharma OP. Neurosarcoidosis: a clinical dilemma. Lancet Neurol 2004;3(7):397–407. doi: 10.1016/S1474-4422(04)00805-1.
6. James DG, Sharma OP. Neurosarcoidosis. Proc R Soc Med 1967;60(11 Part 1):1169–70.
7. Hoitsma E, Drent M, Sharma OP. A pragmatic approach to diagnosing and treating neurosarcoidosis in the 21st century. Curr Opin Pulm Med 2010;16(5):472–479. doi: 10.1097/MCP.0b013e32833c86df.
8. Ungprasert P, Matteson EL. Neurosarcoidosis. Rheumatic Disease Clinics of North America 2017;43(4):593–606. doi: 10.1016/j.rdc.2017.06.008.
9. Alzghoul BN, Amer FN, Barb D, et al. Prevalence and characteristics of self-reported hypothyroidism and its association with nonorgan-specific manifestations in US sarcoidosis patients: a nationwide registry study. ERJ Open Res 2021;7(1):00754–02020. doi: 10.1183/23120541.00754-2020.
10. Smith JK, Matheus MG, Castillo M. Imaging Manifestations of Neurosarcoidosis. American Journal of Roentgenology 2004;182(2):289–295. doi: 10.2214/ajr.182.2.1820289.
11. Koyama T, Ueda H, Togashi K, et al. Radiologic Manifestations of Sarcoidosis in Various Organs. RadioGraphics 2004;24(1):87–104. doi: 10.1148/rg.241035076.
12. Fritz D, van de Beek D, Brouwer MC, Booij J. Whole-Body 18F-FDG PET-CT in the Diagnosis of Neurosarcoidosis. Mayo Clin Proc 2020;95(5):1082–1084. doi: 10.1016/j.mayocp.2020.01.032.
13. Bilgin Topçuoğlu Ö, Kavas M, Öztaş S, et al. EEG in Sarcoidosis Patients Without Neurological Findings. Clin EEG Neurosci 2017;48(1):54–59. doi: 10.1177/1550059416646651.
14. Stern BJ, Royal W, Gelfand JM, et al. Definition and Consensus Diagnostic Criteria for Neurosarcoidosis. JAMA Neurol 2018;75(12):1546. doi: 10.1001/jamaneurol.2018.2295.
15. Dutra LA, Braga-Neto P, Oliveira RA, et al. Neurosarcoidosis: guidance for the general neurologist. Arq Neuropsiquiatr 2012;70(4):293–299. doi: 10.1590/s0004-282x2012000400014.
16. Hebel R, Dubaniewicz-Wybieralska M, Dubaniewicz A. Overview of neurosarcoidosis: recent advances. J Neurol 2015;262(2):258–267. doi: 10.1007/s00415-014-7482-9.
17. Bitoun S, Bouvry D, Borie R, et al. Treatment of neurosarcoidosis. Neurology 2016;87(24):2517–2521. doi: 10.1212/WNL.0000000000003431.
18. Fujisawa M, Kanda T. [Steroid-Resistant Central Nervous System Sarcoidosis: The Selections of Multi-Agent Combination as the Initial Treatment]. Brain Nerve 2022;74(5):455–461. doi: 10.11477/mf.1416202063.
19. Stern BJ, Schonfeld SA, Sewell C, et al. The Treatment of Neurosarcoidosis With Cyclosporine. Arch Neurol 1992;49(10):1065–1072. doi: 10.1001/archneur.1992.00530340089023.
20. Amer F, Alzghoul BN, Jaber JF, et al. Prevalence and Characteristics of Hyperthyroidism Among Patients With Sarcoidosis in the United States. Endocrine Practice 2022;28(7):654–659. doi: 10.1016/j.eprac.2022.03.017.
21. Innabi A, Alzghoul BN, Kalra S, et al. Sarcoidosis among US Hispanics in a Nationwide Registry. Respir Med 2021;190:106682. doi: 10.1016/j.rmed.2021.106682.
22. Sauer WH, Stern BJ, Baughman RP, et al. High-Risk Sarcoidosis. Current Concepts and Research Imperatives. Ann Am Thorac Soc 2017;14(Supplement_6):S437–S444. doi: 10.1513/AnnalsATS.201707-566OT.
23. BAUGHMAN RP, TEIRSTEIN AS, JUDSON MA, et al. Clinical Characteristics of Patients in a Case Control Study of Sarcoidosis. Am J Respir Crit Care Med 2001;164(10):1885–1889. doi: 10.1164/ajrccm.164.10.2104046.
24. Fritz D, van de Beek D, Brouwer MC. Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis. BMC Neurol 2016;16(1):220. doi: 10.1186/s12883-016-0741-x.
25. Te HS, Perlman DM, Shenoy C, et al. Clinical characteristics and organ system involvement in sarcoidosis: comparison of the University of Minnesota Cohort with other cohorts. BMC Pulm Med 2020;20(1):155. doi: 10.1186/s12890-020-01191-x.
26. Zajicek JP. Central nervous system sarcoidosisdiagnosis and management. QJM 1999;92(2):103–117. doi: 10.1093/qjmed/92.2.103.
27. Bihan H, Christozova V, Dumas J-L, et al. Sarcoidosis. Medicine 2007;86(5):259–268. doi: 10.1097/MD.0b013e31815585aa.
28. Stern BJ. Neurologic Sarcoidosis. Accessed December 12, 2022. UpToDate: https://www.uptodate.com/contents/neurologic-sarcoidosis
29. Sherman JL, Stern BJ. Sarcoidosis of the CNS: comparison of unenhanced and enhanced MR images. AJNR Am J Neuroradiol 1990;11(5):915–23.
30. Pawate S, Moses H, Sriram S. Presentations and outcomes of neurosarcoidosis: a study of 54 cases. QJM: An International Journal of Medicine 2009;102(7):449–460. doi: 10.1093/qjmed/hcp042.
31. Ramos-Casals M, Pérez-Alvarez R, Kostov B, et al. Clinical characterization and outcomes of 85 patients with neurosarcoidosis. Sci Rep 2021;11(1):13735. doi: 10.1038/s41598-021-92967-6.
32. Sohn M, Nozaki K, Culver DA, et al. Spinal Cord Neurosarcoidosis. Am J Med Sci 2014;347(3):195–198. doi: 10.1097/MAJ.0b013e3182808781.
33. Cohen-Aubart F, Galanaud D, Grabli D, et al. Spinal Cord Sarcoidosis. Medicine 2010;89(2):133–140. doi: 10.1097/MD.0b013e3181d5c6b4.
34. Bradley DA, Lower EE, Baughman RP. Diagnosis and management of spinal cord sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2006;23(1):58–65.
35. Doty JD, Mazur JE, Judson MA. Treatment of Corticosteroid-Resistant Neurosarcoidosis With a Short-Course Cyclophosphamide Regimen. Chest 2003;124(5):2023–2026. doi: 10.1378/chest.124.5.2023.
36. Scott TF, Yandora K, Valeri A, et al. Aggressive Therapy for Neurosarcoidosis. Arch Neurol 2007;64(5):691. doi: 10.1001/archneur.64.5.691.
37. Moravan M, Segal BM. Treatment of CNS sarcoidosis with infliximab and mycophenolate mofetil. Neurology 2009;72(4):337–340. doi: 10.1212/01.wnl.0000341278.26993.22.
38. Gelfand JM, Bradshaw MJ, Stern BJ, et al. Infliximab for the treatment of CNS sarcoidosis. Neurology 2017;89(20):2092–2100. doi: 10.1212/WNL.0000000000004644.
39. Heij L, Dahan A, Hoitsma E. Sarcoidosis and Pain Caused by Small-Fiber Neuropathy. Pain Res Treat 2012;2012:1–6. doi: 10.1155/2012/256024.