Editorial [Hot Topic:Neuro-Behcet's Syndrome: Finally, New Insights Daniel J. Wallace ]

One of the most frustrating complications of Behcet's disease is the ‘Neuro-Behcet's Syndrome’. Manifested by a combination of factors including headache, motor symptoms, cerebeller dysfunction, dysarthria, sensory alterations, cognitive impairment, seizures and peripheral neuropathy, its management has not adequately been explored. Historically, neuro-Behcet's has been managed with colchicine, corticosteroids, and immune suppressive therapies. It is difficult for the treating doctor to get a handle on the numerous anecdotal reports, case series and reported experiences on how best to manage this aspect of the disease. In this issue of Current Rheumatology Reviews, Dr. Hirohata fills the void with a highly readable, well referenced, critical review of the management of Neuro-Behcet's. He distills the literature and focuses on what is important and clinically relevant. Additionally, newer therapies, including biologics are reviewed. Neuro-Behcet's is best managed by dividing it into acutely active, recently active with emphasis on prevention of relapse, and chronic progressive. Using this classification, Dr. Hirohata guides the reader through various options which are available, taking into consideration the dearth of prospective, double-blind, placebo controlled studies in this area. This provides the practitioner with all the experience he would need in order to tailor management for a specific Behcet's patient. The most interesting aspect of the review details the author's experience with using cerebrospinal fluid IL-6 to follow disease activity. We may finally have a biomarker applicable to the bedside which may help us serially follow patients.