Rapid Improvement in Cerebral Palsy Following Treatment With Perispinal Etanercept: A Case Report

Etanercept, a selective inhibitor of the cytokine tumor necrosis factor (TNF), delivered by perispinal administration, has been used clinically for 15 years to treat chronic, intractable, post-stroke and post-brain injury neurological dysfunction. We report the case of a 19-year-old patient with cerebral palsy (CP) who experienced rapid and sustained neurological improvement after treatment with perispinal etanercept (PSE). The patient was born at 25 weeks gestation following a twin pregnancy complicated by abruptio placentae and premature onset of labor. The initial head ultrasound, performed four weeks after birth, demonstrated grade four intraventricular hemorrhage (IVH) with acquired ventriculomegaly and the patient was subsequently diagnosed with CP, hydrocephalus, and retinopathy of prematurity. She presented at age 19 to our clinic with chronic right hemiparesis, bilateral upper limb fine motor dysfunction, painful spasticity and multiple, additional chronic neurological symptoms. The patient received an initial 25mg dose of PSE, followed by doses at weeks three, 24 and 49. The patient reported reduced painful spasticity and improved sensation within 30 minutes of each dose. Clinically meaningful improvements that persisted over the entire one-year period of observation were noted in painful spasticity, sensation, gait, mobility, balance, coordination, fine motor function, strength, fatigue, and headaches; some of the improvements were progressive. PSE was well tolerated. Further study of PSE for selected patients with CP in properly designed, randomized, controlled trials is warranted.