Objective:

To determine how seizures impact the management of neurosarcoidosis and affect long-term outcomes. 

Background:

Though neurosarcoidosis can injure the cerebral cortex via several mechanisms, seizures are uncommonly reported as a clinical manifestation of the disease (4-15%) and have been previously associated with a more severe course.

Design/Methods:

Patients with a diagnosis of neurosarcoidosis were included in this retrospective cohort analysis if seizures were a clinical manifestation of their disease.  

Results:

Seizures were present in 26/216 (12.0%) patients and were an initial manifestation of neurosarcoidosis in 11/26 (42.3%). None had a pre-existing seizure disorder. Semiologies were reported in 23: generalized in 12/23 (52.2%), focal in 9/23 (39.1%), and both in 2/23 (8.7%). Status epilepticus occurred in 6/26 (23.1%); 2 (7.7%) were intubated. MRIs were obtained in 25 with cerebral parenchymal lesions (18/25, 72.0%) being the most common radiographic accompaniment, followed by leptomeningitis (13/25, 52.0%) and pachymeningitis (10/25, 40.0%). EEGs showed focal slowing in 12/19 (63.1%), focal epileptiform discharges in 5/19 (26.3%), no abnormalities in 4/19 (21.1%), generalized slowing in 2/19 (10.5%), and epileptiform discharges of unclear distribution in 1/19 (5.3%). No patients had generalized epileptiform discharges. Seizures were controlled in 22/26 (84.6%) compliant with antiseizure medicines (ASMs). Most (18/26, 69.2%) required only 1 medicine for control with levetiracetam being beneficial in 22/22 (100%) trialed. 17/25 (68.0%) had 6 or fewer lifetime seizures. 2/26 (7.7%) were ultimately weaned off ASMs. 13/26 (50.0%) required two or more lines of immunosuppression, all of whom received biologic treatments. The average last mRS was 2.0. No patients died as a result of seizures. Median follow-up of 68.4 months. 

Conclusions:

Seizures in neurosarcoidosis occur most commonly with cerebral parenchymal lesions and are relatively easy to control with ASMs, but the accompanying neuroinflammation is often challenging to treat with a high reliance on biologic therapies for management.