title: Crohn's disease: is there a place for neurological screening?
abstract: OBJECTIVE
  Neurological complications of inflammatory bowel diseases (IBDs) are not rare but are under-diagnosed; some are probably immune-mediated. Several previous studies have suggested a higher incidence of demyelinating diseases such as multiple sclerosis in IBD patients. In this single-center, prospective, observational study, the authors focus on T2 focal white-matter lesions of the central nervous system on magnetic resonance imaging (MRI) in IBD patients that may be due to demyelination.
  
  
  METHODS
  A total of 70 patients with Crohn's disease were examined before beginning anti-TNF-α therapy. These patients were treated with azathioprine, mesalazine or both. Patients were examined by a neurologist to detect possible signs of demyelinating disease, and patients underwent brain MRI (native T1, T2, and FLAIR sequences).
  
  
  RESULTS
  Thirty-seven patients (53%) exhibited abnormalities on neurological examination, and 26 patients (37%) displayed abnormalities on MRI. In seven cases, these MRI abnormalities (periventricular lesions) were suspected to be due to demyelination. Cerebral spinal fluid investigation (including polyclonal bands) was completely negative in five cases and was borderline in one case, and multiple sclerosis was confirmed in one case. Pathological MRI findings in 19 other patients were clinically nonsignificant; most were nonspecific sporadic lesions in white matter or mild atrophy.
  
  
  CONCLUSIONS
  The results support previous data that the frequency of neurological findings in IBD patients is generally underestimated. With the extension of biological anti-TNF-α treatment for IBD, the possibility of a higher risk of developing multiple sclerosis should be considered.
authors.affiliation: Gastroenterology, Clinic of Internal Medicine, 2nd Medical Faculty of Charles University , Prague , Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Stovicek
authors.forename: Petra
authors.initials: P
authors.lastname: Liskova
authors.forename: Jiri
authors.initials: J
authors.lastname: Lisy
authors.forename: Stepan
authors.initials: S
authors.lastname: Hlava
authors.forename: Radan
authors.initials: R
authors.lastname: Keil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D003711:Demyelinating Diseases / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha