Proposing an algorithm for treatment of different manifestations of neuro-Behcet's disease.
"Neuro-Behcet's disease" (NBD) is the constellation of neurologic manifestations as a direct consequence of Behcet's disease usually confirmed by imaging studies and/or cerebrospinal fluid analysis. The authors propose a therapeutic algorithm for neuro-Behcet's disease based upon pathological, clinical, prognostic, and medico-economical issues based on available evidences. The authors divide anti-NBD armamentarium to first-line, second-line, and experimental drugs. These drugs should be administered hierarchically in treatment of parenchymal manifestations of neuro-Behcet's disease. First-line drug include corticosteroids, azathioprine, methotrexate, and cyclophosphamide. Second-line drugs are tumor necrosis factor (TNF) alpha blocking drugs, interferon-alpha, chlorambucil, and mycophenolate mofenil. Experimental drugs include other "targeted therapies" than anti-TNF antibodies, tolerization therapy and stem cell transplantation. Cerebral venous sinus thrombosis associated with Behcet's disease should be treated by short-term corticosteroids and anticoagulation with or without immunosuppressive drugs.
Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. borhanihaghighi@yahoo.com
Afshin
A
Borhani Haghighi
Anahid
A
Safari
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D001528:Behcet Syndrome / Q000473:pathology / Q000628:therapy*; D001921:Brain / Q000473:pathology; D003661:Decision Support Techniques; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D001379:Azathioprine; D008727:Methotrexate