title: Mycophenolate mofetil as a novel immunosuppressant in the treatment of neuro-Behçet's disease with parenchymal involvement: presentation of four cases.
abstract: OBJECTIVE
  Behçet's disease is a multisystemic, relapsing, inflammatory disorder of unknown origin. Among Turkish cohorts, 5-15% of patients show involvement of the central nervous system (CNS) at some time during their disease. There are mainly two types of clinical presentation: parenchymal CNS inflammation manifesting mainly as meningoencephalitis of the brainstem, or dural sinus thrombosis. Several drugs like high-dose steroids or immunosuppressive agents, mainly azathioprine, are used in the treatment. For patients who do not respond sufficiently to these agents or are not able tolerate them, other options are needed.
  
  
  METHODS
  We are presenting 4 cases with parenchymal neuro-Behçet's disease, where commonly used immunosuppressive drugs could not be continued due to intolerance or inefficacy. However, the patients benefited well from mycophenolate mofetil. The benefit was sustained during 3-7 years of follow-up (median 6.5 years).
  
  
  CONCLUSIONS
  Mycophenolate mofetil seems to be an alternative drug in parenchymal neuro-Behçet's disease; however, large controlled studies should be performed for verification of our results.
authors.affiliation: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
authors.forename: Erkingül
authors.initials: E
authors.lastname: Shugaiv
authors.forename: Erdem
authors.initials: E
authors.lastname: Tüzün
authors.forename: Melike
authors.initials: M
authors.lastname: Mutlu
authors.forename: Asli
authors.initials: A
authors.lastname: Kiyat-Atamer
authors.forename: Murat
authors.initials: M
authors.lastname: Kurtuncu
authors.forename: Gulsen
authors.initials: G
authors.lastname: Akman-Demir
mesh_terms: D000328:Adult; D001528:Behcet Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008590:Meningoencephalitis / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D008636:Mesencephalon / Q000473:pathology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011149:Pons / Q000473:pathology; D012851:Sinus Thrombosis, Intracranial / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid