Summer 2012

Game Changers for Neuro-Inflammatory Disorders

"Research advances enable us to better diagnose and treat inflammatory disorders once considered untreatable," says neuroimmunologist Jeffrey Gelfand, M.D., of the Neuroimmunology Clinic within the UCSF Multiple Sclerosis Center.

Dr. Jeffrey Gelfand

Dr. Jeffrey Gelfand

The clinic focuses on neuroimmunologic disorders of the central nervous system other than multiple sclerosis (MS), such as sarcoidosis and neurological manifestations of systemic inflammatory (rheumatological) diseases. It relies on advanced technology and access to research to offer patient-centered, evidence-based care.

Colleagues from rheumatology, ophthalmology and pulmonology participated in the clinic's development because "many of these conditions are systemic in origin and we need to care for the whole patient — not just narrowly focus on one part of their syndrome," Gelfand says.

A Diagnostic Center of Excellence

The clinic addresses a number of unmet needs, including serving as a diagnostic center of excellence for difficult-to-diagnose patients. "We take a detailed, targeted approach to evaluation and are committed not just to ruling out conditions, but to identifying the final diagnosis," Gelfand says.

Sarcoidosis is of particular interest because it causes symptoms that can mimic many other conditions and sometimes requires very different treatment approaches than those used for other neuroimmunological diseases. Therefore, it's particularly important to rigorously rule out potential diagnoses that include infections, malignancies and other inflammatory diseases.

"To make the sarcoidosis diagnosis, the gold standard is pathology," says Gelfand. "Neurosurgeons at UCSF are world experts in such procedures, but sometimes a biopsy from the nervous system is not preferred or possible."

Other options include a biopsy from another organ system or use of supportive tests, such as 'imaging, blood tests and spinal fluid exams. Ready access to other neurologists; specialists such as pulmonologists, rheumatologists, ophthalmologists and cardiologists; and state-of-the-art radiological and nuclear imaging is essential because of the many organ systems where sarcoidosis can turn up.

"We also have a neurodiagnostics center integrated within the neurology clinic, where we do visual and somatosensory evoked potentials, retinal scans [optical coherence tomography] and vision testing," Gelfand says.

The results can make an enormous difference in patients lives. Gelfand has seen patients referred for suspected neurosarcoidosis who turned out to have other conditions, which in many cases were amenable to treatment.

Long-Term, Collaborative Care

Gelfand is quick to add that his clinic's services extend beyond one-time consults to partnering with referring physicians to optimize longitudinal care.

"We'll co-manage patients with a focus on improving functional outcomes, using treatment approaches that range from first-line therapies, such as steroids, to the use of oral immunosuppressants and biological agents, as well as symptom management," he says.

A final advantage is the clinic's ability to rapidly translate neuroimmunological discoveries into new treatment modalities.

"Better understanding these conditions will help us better treat all our patients, including those with MS," says Ari Green, M.D., assistant director of the Multiple Sclerosis Center.

"Care for many of these conditions is being optimized as we speak," Gelfand says. "It's an exciting time."

For more information, contact Dr. Jeffrey Gelfand at the UCSF Multiple Sclerosis Center at (415) 353-2069.


Neurosciences — Summer 2012 Index

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