Modified Rankin Scale Outcomes in Neurosarcoidosis: Associations with Clinical and Diagnostic Features

Objective To evaluate functional outcomes in neurosarcoidosis (NS) using the modified Rankin Scale (mRS) and assess associations between functional outcomes in the context of clinical presentation and diagnostic findings. Background NS is a rare manifestation of sarcoidosis occurring in isolation or with systemic disease. No randomized controlled trials exist. Studies rely on remission, progression, or imaging, which may not capture functional disability. mRS measures functional outcomes. Design/Methods We retrospectively assigned mRS scores at baseline and 1 year in 50 patients with definite or probable NS (2018 Neurosarcoidosis Consortium Consensus). Associations between mRS outcomes and diagnostic (biopsy site, imaging, EEG) and clinical variables were assessed using nonparametric and categorical analyses. Logistic regression identified predictors of improvement. Results This study included 50 patients (mean age at diagnosis 50 years). ΔmRS ranged from –2 to +3; at 1 year, 30% improved, 54% remained stable, and 16% worsened. These findings indicate that most patients experienced stable functional status over time, with a smaller proportion demonstrating improvement or decline. Facial palsy was significantly associated with improvement, with 75% of affected patients improving compared to 21% without (Fisher’s exact p = 0.006). Diagnostic modalities (skin, lung, and brain biopsy; CT, PET, EEG) were not associated with baseline mRS, ΔmRS, or likelihood of improvement. In logistic regression, facial palsy remained independently associated with improvement (OR 11.19, p = 0.008), while brain biopsy status was not associated with outcome (OR 0.46, p = 0.343). The overall model was significant (χ 2 = 9.41, p = 0.009; Nagelkerke R 2 = 0.243), indicating moderate explanatory power. Conclusions Functional outcomes in NS demonstrate limited change over time and appear more closely associated with clinical phenotype than the diagnostic classification of definite or probable. Facial palsy may represent a reversible disease phenotype. These findings support mRS as a functional outcome measure and highlight the importance of clinical presentation.