Left untreated, symptoms may resolve spontaneously after an average of about eight weeks. Glucocorticoids have long been the recommended treatment for Tolosa Hunt syndrome. Little consideration has been given to alternative therapies, probably due to the typical rapid response to glucocorticoids (pain usually resolves within 24 to 72 hours after starting treatment). However, there are little data other than case series to determine the most effective dose, the route and schedule of administration, or the length of therapy. Furthermore, while it is known that glucocorticoids relieve the pain associated with the condition, there is no definitive evidence that associated cranial neuropathies recover any faster with or without treatment. A few affected individuals may need other immunosuppressive medications either to limit the complications of corticosteroid use or to keep the disorder in remission. These individuals typically undergo a biopsy to confirm the diagnosis of THS.
Close follow-up with repeat MRI is typically recommended to confirm glucocorticoid treatment remains effective and no evidence of another cause for the symptoms develops. Improvement seen on MRI is often not seen until several weeks after signs and symptoms improve.
Last updated: 3/25/2013
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