Thalidomide as a Steroid Sparing Agent in Refractory Neurosarcoidosis

Sarcoid is a multi-system granulomatous disease of unknown etiology that is mediated by macrophages, activated T-cells and cytokines IL-2, IL-12, and TNF alpha. Neurosarcoid occurs in approximately 5% of patients. Corticosteroids are the primary treatment for neurosarcoidosis; however, one-third of patients are refractory to corticosteroids alone and may require a steroid-sparing agent. Thalidomide inhibits macrophages, T-cells and suppresses IL-2 and IL-12 and TNF-alpha.