title: Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors.
abstract: BACKGROUND
  TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes.
  
  
  OBJECTIVE
  To present 10 new cases of TNFAI associated neurological disease and a review of the literature.
  
  
  METHODS
  The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review.
  
  
  RESULTS
  We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84% of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71%. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67% of cases although 82% had been followed for less than one year.
  
  
  CONCLUSIONS
  Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.
authors.affiliation: Department of Neurology, University of Vermont College of Medicine, Fletcher Allen Health Care, University Health Center, Vermont 05401, USA. andrew.solomon@vtmednet.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Solomon
authors.forename: Rebecca I
authors.initials: RI
authors.lastname: Spain
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kruer
authors.forename: Dennis
authors.initials: D
authors.lastname: Bourdette
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003711:Demyelinating Diseases / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D009902:Optic Neuritis / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D014409:Tumor Necrosis Factor-alpha