Journal article
Consensus Recommendations for the Management of Neurosarcoidosis: A Delphi Survey of Experts Across the United States
Neurology. Clinical practice, Vol.15(2), e200429
04/2025
DOI: 10.1212/CPJ.0000000000200429
PMCID: PMC11737638
PMID: 39830676
Abstract
Neurosarcoidosis poses a diagnostic and management challenge due to its rarity, phenotypic variability, and lack of randomized controlled studies to guide treatment selection. Recommendations for management based on expert opinion are useful in clinical practice and provide a framework for designing prospective studies.
In this Delphi survey study, specialists with experience in managing patients with neurosarcoidosis were invited to anonymously complete 2 surveys about key elements of evaluation, diagnosis, treatment, monitoring, and long-term management of neurosarcoidosis. Expert consensus recommendations were adopted if >80% threshold of agreement was reached.
Of the 41 invited expert clinicians across the United States, 32 (78%) participated in the study. All round 1 respondents self-identified as neuroimmunologists (except for 1 pulmonologist). Consensus was reached regarding the need to consider neurosarcoidosis phenotype and severity to guide the choice of initial immunosuppression in both the acute (relapse) and maintenance phases. Experts endorsed the use of TNF-α inhibitors as first-line agents in selected phenotypes with poor prognosis. Neuroimaging was recommended to complement clinical surveillance for treatment response.
There was agreement on several key issues, most importantly on the need to consider neurosarcoidosis phenotype and severity when deciding initial treatment. No consensus was achieved on the dosing and duration of specific immunosuppressants, nor regarding the management of the peripheral nervous system manifestation of neurosarcoidosis. These topics warrant further investigation.
Details
- Title: Subtitle
- Consensus Recommendations for the Management of Neurosarcoidosis: A Delphi Survey of Experts Across the United States
- Creators
- Giovanna Sophia Manzano - Massachusetts General HospitalJames Eaton - Vanderbilt University Medical CenterMichael Levy - Massachusetts General HospitalJustin R Abbatemarco - Cleveland ClinicAllen J Aksamit - Mayo Clinic in ArizonaPria Anand - Boston Medical CenterDenis T Balaban - Massachusetts General HospitalPaula Barreras - Cedars-Sinai Medical CenterRobert P Baughman - University of CincinnatiShamik Bhattacharyya - Brigham and Women's HospitalRoberto Bomprezzi - Department of Neurology, University of Massachusetts Memorial HealthTracey A Cho - University of Iowa Hospitals and ClinicsBart Chwalisz - Massachusetts General HospitalStacey Lynn Clardy - University of UtahDavid B Clifford - Washington University in St. LouisEoin P Flanagan - Mayo Clinic in ArizonaJeffrey M Gelfand - University of California, San FranciscoGeorge Kyle Harrold - Massachusetts General HospitalSpencer K Hutto - Emory UniversitySiddharama Pawate - Vanderbilt University Medical CenterNoellie Rivera Torres - University of PennsylvaniaLama Abdel-Wahed - University of Iowa Hospitals and ClinicsSteven Richard Dunham - Washington University in St. LouisRajesh Kumar Gupta - The University of Texas Health Science Center at HoustonBrandon Moss - Cleveland ClinicCarlos A Pardo - Johns Hopkins UniversityRohini D Samudralwar - University of PennsylvaniaNagagopal Venna - Massachusetts General HospitalAram Zabeti - University of CincinnatiIlya Kister - NYU Langone Health
- Resource Type
- Journal article
- Publication Details
- Neurology. Clinical practice, Vol.15(2), e200429
- DOI
- 10.1212/CPJ.0000000000200429
- PMID
- 39830676
- PMCID
- PMC11737638
- NLM abbreviation
- Neurol Clin Pract
- ISSN
- 2163-0402
- eISSN
- 2163-0933
- Language
- English
- Date published
- 04/2025
- Academic Unit
- Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984775021902771
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