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Significant recovery of motor function in a patient with complete T7 paraplegia receiving etanercept
Mickaël Dinomais1, Laura Stana, Guy Egon
1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Angers, France.
Objective:
To report an unusual case of significant motor recovery in a patient with T7 complete paraplegia treated with etanercept for ankylosing spondylitis.
Design:
Case report.
Results:
During the first year sensory-motor recovery occurred, and the American Spinal Injury Association Impairment Scale (AIS) improved from A to D.
Conclusion:
Initial spinal cord injury is a direct consequence of the trauma. It triggers a series of molecular and cellular reactions leading to "secondary damage". Tumour necrosis factor alpha is a key inflammatory mediator that is increasingly expressed after spinal cord injury. Etanercept is a recombinant dimer of human tumour necrosis factor alpha receptor protein that inhibits tumour necrosis factor alpha activity. It has shown an immunomodulatory effect in mice after traumatic spinal cord injury. It significantly reduced the post-traumatic spinal cord inflammation and the perilesional area. In this case, a reduction in the secondary damage, due to etanercept treatment could explain the significant motor recovery, which is unusual since 80% of AIS A lesions remain complete.