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Visualizing Impairment of the Endothelial and Glial Barriers of the Neurovascular Unit during Experimental Autoimmune Encephalomyelitis In Vivo
Published on: March 26, 2019
Severe Immune-Related Neurological Adverse Events Associated With Immune Checkpoint Inhibitor Treatment: A
Anna Grisold1,2, Angelika M Starzer3,4, Sara Silvaieh1,2
1Department of Neurology, Medical University of Vienna, Vienna, Austria.
European Journal of Neurology
|June 2, 2026
Summary
Severe neurological immune-related adverse events (n-irAEs) from immune checkpoint inhibitors (ICIs) are rare but require vigilance. Most patients experience improvement with treatment discontinuation or immunomodulation.
Area of Science:
- Neuro-oncology
- Immunology
- Clinical Neurology
Background:
- Immune checkpoint inhibitors (ICIs) have transformed cancer treatment.
- ICI therapy can activate the immune system, potentially causing neurological immune-related adverse events (n-irAEs).
- Characterizing severe n-irAEs is crucial for patient safety.
Purpose of the Study:
- To retrospectively analyze severe (grade ≥3) n-irAEs in patients treated with ICIs.
- To report the clinical characteristics, neurological manifestations, and outcomes of severe n-irAEs.
- To assess the incidence and management of n-irAEs in a monocentric cohort.
Main Methods:
- Screened a registry of patients treated with ICIs between 2007 and 2023.
- Identified patients who underwent neurological evaluation and reviewed their medical records.
- Analyzed clinical and demographic data, neurological symptoms, treatment, and outcomes for severe n-irAE cases.
Main Results:
- Severe n-irAEs occurred in 0.5% (10/2043) of patients.
- Neuromuscular and peripheral nerve involvement (myasthenia, myositis, polyneuropathy, facial nerve palsy) was most common (7/10 cases).
- Central nervous system involvement included meningitis, myelitis, and stroke; 7/10 patients improved, and no deaths were ICI-related.
Conclusions:
- Severe n-irAEs are uncommon but necessitate clinical vigilance for delayed neurotoxicity.
- Prompt discontinuation of ICIs and/or immunomodulatory treatments can lead to clinical improvement.
- Awareness of potential delayed-onset neurotoxicity is important, even with prolonged ICI exposure.
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