Silva, LéniaSilva, Isabel FonsecaFonseca, TomásPinto, Luísa SerpaLeal, BárbaraPinho e Costa, PauloIgreja, LilianaMoreira, BrunoSantos, ErnestinaVasconcelos, CarlosMarinho, AntónioCorreia, João Araújo2026-02-162026-02-162025-05-22J Neuroimmunol. 2025 Sep 15:406:578647. doi: 10.1016/j.jneuroim.2025.578647. Epub 2025 May 220165-5728http://hdl.handle.net/10400.18/10942Background: Behçet disease (BD) is a systemic vasculitis affecting multiple organs with a wide range of severity. Neuro-Behçet (NBD) is a severe form, characterized by high morbidity, disability, and mortality rates. Methods: Retrospective analysis (1993-2023) of neurological involvement in BD patients at a tertiary center. Results: Of 296 BD patients, 93(31.4 %) underwent neurological evaluation. Definite NBD was identified in 30(10.1 %), probable NBD in 2(0.5 %) and "other neurological symptoms in BD" in 26(8.6 %) patients. The definite NBD group (median age: 36 years, 50 % female) had 44 neurological attacks: 24(55 %) parenchymatous and 20(45 %) non-parenchymatous. The most common syndromes were brainstem (27.3 %) and multifocal (25.6 %), with ataxia being the most frequent sign (40.9 %). One-third had a relapsing course. NBD onset concurred with BD diagnosis in 50 % of cases, followed in 30 %, and preceded in 20 %. Brain MRI revealed predominant involvement of the brainstem and diencephalic regions. The HLA-B*51 allele was more prevalent in definite NBD versus BD patients (53.8 % vs 31.2 %, p = 0.036). Treatments included corticosteroids (70.5 %), cyclophosphamide (15.9 %), infliximab (9.1 %), and conventional synthetic disease-modifying antirheumatic drugs (13.6 %). Better outcomes were achieved with cyclophosphamide and infliximab. The probable NBD and "other neurological symptoms in BD" groups (median age: 37 years) were mostly female (92.9 %). Headache (85 %) and cognitive complaints (23 %) were common symptoms.Highlights: -10.1 % of Behçet patients had definite neuro involvement in a 30-year study. -Neurological symptoms preceded Behcet diagnosis in 20 % of cases. -Chronic headaches were frequent in Behcet patients, but unrelated to direct CNS involvement. -HLA-B*51 was linked to definite neuro-Behcet, with OR = 2.56 (p = 0.036). -Anti-TNFα drugs and cyclophosphamide were highly effective treatments.engBehçet's DiseaseDiagnosisNeuro-BehçetOutcomeTreatmentDoenças Genéticasjournal article10.1016/j.jneuroim.2025.5786471872-842140414042