This protocol applies to patients with neurosarcoidosis presenting with mild to moderately disabling neurological disease. The affected presentations include cranial neuropathies of nerves II and VIII, meningeal mass lesions, hydrocephalus, CNS parenchymal disease, peripheral neuropathies, and generalised myopathies.
The first-line approach for this degree of neurological involvement is oral prednisone given daily for at least one month, followed by a planned taper. Escalation to this protocol is indicated when clinical improvement has not been achieved within one month of starting that regimen.
When corticosteroid monotherapy does not achieve the expected response, the next step involves adjusting corticosteroid dosing and adding an adjuvant cytotoxic agent early in the course — an approach intended to limit long-term corticosteroid complications in patients likely to require prolonged treatment.
It is suggested that patients with mild to moderately disabling disease (cranial nerves II and VIII, meningeal mass lesions, hydrocephalus, CNS parenchymal disease, neuropathies and generalized myopathies) be treated with 20-30 mg prednisone daily for at least one month.
Corticosteroid treatment is recommended as the first line of therapy for neurologic involvement.
In order to avoid the long-term complications of corticosteroid therapy, use of adjuvant cytotoxic therapy is recommended early in the clinical course of patients who are likely require prolonged treatment.
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