＜シンポジウム（3）―3―4＞中枢神経を侵す難治性炎症性疾患の治療法の選択と最適化：Q&A
中枢神経サルコイドーシス：診断と治療
熊本 俊秀
大分大学医学部総合内科学第三講座〔〒879―5593 大分県由布市挾間町医大ヶ丘1丁目1番地〕
Sarcoidosis is a multisystem inflammatory granulomatous disease that affects the central nervous system (CNS). CNS Involvement occurs in a relatively small number of patients with sarcoidosis but is potentially serious manifestation. Diagnostic criteria usually include histologic identification of a noncaseating epithelioid granuloma, supportive laboratory or neuroimaging tests or both, and a compatible clinical course. Diagnostic criteria proposed by "The Diagnosis Guideline for Sarcoidosis in Japan -2006" can distinguish definite, probable, and possible neurosarcoidosis, and may be now commonly used. Patients with a definite or probable diagnosis of CNS sarcoidosis should start treatment promptly. The pharmacologic regimens for the treatment of neurosarcoidosis are not standardized since no prospective, randomized, controlled trials have been performed in the World. Corticosteroids, however, are typically the first line or therapy and approximately half of patients have substantial benefit. For patients who are refractory to or intolerant of corticosteroid therapy, second-line agents include azathioprine, methotrexate, cyclosporine, cyclophosphamide, and mycophenolate mofetil (MMF). Treatment regimens vary in term of doing, maintenance, and tapering. Radiotherapy or neurosurgical treatment is indicated when medications fail or when life-threatening emergences, such as severe hydrocephalus and elevated intracranial pressure, arise. The combination of infliximab, an anti-TNF-alpha neutralizing antibody, and MMF has recently been used to treat neurosarcoidosis. Treatment option will likely evolve as well-designed studies are undertaken.
Full Text of this Article in Japanese PDF (220K)
(臨床神経, 52：1237−1239, 2012)
key words：神経サルコイドーシス，中枢神経系，免疫抑制薬，ステロイド，インフリキシマブ
（受付日：2012年5月25日）
