Clinical implications of seizures in neurosarcoidosis
A. Krumholz, B. J. Stern and E. G. Stern
Department of Neurology, University of Maryland School of Medicine, Baltimore.
Seizures are a recognized manifestation of neurosarcoidosis, but their
clinical relevance is not well established. We reviewed the
characteristics, clinical correlations, and prognosis of seizures in 79
patients with neurosarcoidosis. Thirteen (15%) of the 79 patients had
seizures, and in eight patients (10%) a seizure was the first manifestation
of neurosarcoidosis. These seizures were generalized tonic-clonic seizures
in 12 patients (92%) and partial seizures in four patients (31%). The
patients with neurosarcoidosis with seizures were more likely to have a
progressive or relapsing clinical course and intracranial mass lesions
(four patients [31%]), encephalopathy or vasculopathy (eight patients
[62%]), or hydrocephalus (five patients [38%]). These central nervous
system disorders, rather than the seizures per se, were responsible for
most of the serious morbidity and the two deaths (15%) among our patients
with seizures. Indeed seizure control was good in 11 (85%) of 13 patients
treated with combinations of steroids and antiepileptic medications.
Seizures are an important sign in neurosarcoidosis because they are
associated with more severe and progressive or relapsing forms of central
nervous system sarcoidosis and may be an early manifestation of such
disorders.
