Objective: To assess the frequency of extrapyramidal signs in patients with NS compared to patients with MS.

Background: Specific inflammatory pathways and specifically Tumor necrosis alpha (TNFα) have been associated with the neurodegeneration in Parkinson’s disease (PD). TNFα is also known to play an important role in the pathogenesis of sarcoidosis and TNF blockers can ameliorate the disease. In contrast, multiple sclerosis (MS) is clearly exacerbated by anti- TNFα medications. We have therefore hypothesized that Parkinson-like disease would be more common in neurosarcoidosis (NS) compared to MS.  

Methods: In this case-control study the medical records of patients with NS and of age and gender matched MS patients were reviewed and data regarding the clinical features associated with the disease, ancillary tests performed, treatment, and outcome were documented. Patients were then examined in a uniform manner for the presence of extrapyramidal signs.

Results: In the NS group 8 patients had minor signs, one had mild functional disability and 3 subjects had significant extrapyramidal signs compatible with the diagnosis of PD. All extrapyramidal signs found in 5 of the MS group were minor. The proportional severity of extrapyramidal signs was significantly higher (p = 0.045, chi square test) in the NS group compared to the MS group. 

Conclusions: The specificity of extrapyramidal to NS raises the intriguing question of whether specific inflammatory pathways involving TNFα play a role in the pathogenesis of Parkinson’s disease and therefore may be a therapeutic target.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/extrapyramidal-signs-in-neurosarcoidosis-versus-multiple-sclerosis-is-tnf-alpha-the-link/