Journal article
A Multi-Center Retrospective Cohort Study of Neurosarcoidosis Myelitis: Current Observations and Future Directions
Annals of clinical and translational neurology, Vol.12(12), pp.2589-2599
12/2025
DOI: 10.1002/acn3.70200
PMCID: PMC12698951
PMID: 40963302
Abstract
The optimal treatment for neurosarcoidosis myelitis is uncertain. We characterize incident neurosarcoidosis myelitis and assess treatment response by MRI and clinical scales.
Incident probable or definite neurosarcoidosis myelitis in adults was retrospectively identified from 13 academic medical centers. Cases were analyzed by initial treatment. The primary outcome was T1 post-contrast gadolinium enhancement resolution at 6 months post-treatment. Secondary outcomes were changes in modified Rankin scale (mRS) and Expanded Disability Status Scale (EDSS) from nadir to final follow-up.
Two hundred two patients were identified (median diagnosis age: 47 years (IQR 39-55); male: female 1.3:1). Median nadir mRS and EDSS were 2 (IQR 2-3) and 4 (IQR 2.5-6). At initial treatment, 129 (63.9%) received prolonged corticosteroids ≥ 4 weeks (group A
), 36 (17.8%) received corticosteroids < 4 weeks (B
), 21 (10.4%) received corticosteroids plus sarcoidosis-directed immunosuppressant (E), and 16 (7.9%) received corticosteroids plus non-sarcoidosis-directed agents (F). In 167 cases with sufficient imaging, there were no significant differences in contrast enhancement resolution at 6 months (A
27/106 (25.5%), B
9/28 (32.1%), E 5/19 (26.3%), F 5/14 (35.7%); Fisher's exact p = 0.76). There were no significant differences in changes in mRS or EDSS among treatment groups (Kruskal-Wallis p = 0.69 and 0.63, respectively) after median follow-up of 46.5 months (IQR 18-91.3).
Different initial immunosuppression strategies did not correlate with MRI contrast enhancement resolution at 6 months or clinical scales (mRS, EDSS). However, conclusions are limited by retrospective design, imbalanced cohorts, and insensitivity of binary MRI outcomes and available clinical scales for treatment response in neurosarcoidosis.
Details
- Title: Subtitle
- A Multi-Center Retrospective Cohort Study of Neurosarcoidosis Myelitis: Current Observations and Future Directions
- Creators
- Giovanna S Manzano - Mass General BrighamDenis Balaban - Mass General BrighamYihan Zhang - Mass General BrighamBrian Healy - Mass General BrighamBart K Chwalisz - Mass General BrighamMichael Levy - Mass General BrighamNagagopal Venna - Mass General BrighamBarney J Stern - Johns Hopkins MedicineCarlos A Pardo - Johns Hopkins MedicinePaula Barreras - Cedars-Sinai Medical CenterNicole Bou Rjeily - Johns Hopkins MedicineEoin P Flanagan - Mayo ClinicVyanka Redenbaugh - Mayo ClinicAllen J Aksamit Jr - Mayo ClinicSpencer Hutto - Emory UniversityMax Herman - Emory UniversitySally El Sammak - Emory UniversityElsa C Rodriguez - Florida CollegeLaura Snider - Erlanger Health SystemHannah Rains - Florida CollegeMayra Montalvo - Florida CollegeTorge Rempe - Florida CollegeSergi Martinez Ramirez - Boston Medical CenterLucas Horta - Emory UniversityStacey Clardy - University of UtahJennifer Lord - University of UtahTracey A Cho - University of IowaLama Abdel Wahed - University of IowaJoseph R Berger - University of PennsylvaniaRohini D Samudralwar - University of PennsylvaniaNoellie Rivera Torres - Department of Neurology, Veterans Affairs (VA) Caribbean Healthcare System, San Juan, Puerto RicoDavid B Clifford - Washington University in St. LouisSteven Richard Dunham - Washington University in St. LouisMasoud Majed - Washington University in St. LouisAram Zabeti - University of CincinnatiSamuel Marcucci - University of CincinnatiYang Mao-Draayer - Oklahoma Medical Research FoundationJon Doty - Michigan Institute for Neurological DisordersPaunel B Agyei - The University of Texas Health Science Center at HoustonShamik Bhattacharyya - Mass General Brigham
- Resource Type
- Journal article
- Publication Details
- Annals of clinical and translational neurology, Vol.12(12), pp.2589-2599
- DOI
- 10.1002/acn3.70200
- PMID
- 40963302
- PMCID
- PMC12698951
- NLM abbreviation
- Ann Clin Transl Neurol
- ISSN
- 2328-9503
- eISSN
- 2328-9503
- Publisher
- Wiley
- Language
- English
- Electronic publication date
- 09/17/2025
- Date published
- 12/2025
- Academic Unit
- Neurology; Iowa Neuroscience Institute; Medicine Administration
- Record Identifier
- 9984963629102771
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