Re: Demyelination Concerns

[Guest guest]

Dear ;

I'm very sorry to hear about Pearl Ann's new symptoms. If Pearl Ann's

gastroenterologist is concerned about demyelination, it would probably

be a good idea to cease Remicade (infliximab) infusions for a while (if

this has not already been done). This article indicates that " Most

neuropathies improve over a period of months by withdrawal of the TNF-

alpha antagonist, with or without additional immune-modulating

treatment. " :

Muscle Nerve. 37: 281-292 (2008)

Tumor necrosis factor-alpha antagonists and neuropathy.

Stübgen JP

Department of Neurology and Neuroscience, Cornell University Medical

College, New York Presbyterian Hospital, 525 East 68th Street, New

York, NY 10065-4897, USA. pstuebge@...

Tumor necrosis factor (TNF)-alpha plays an important role in many

aspects of immune system development, immune-response regulation, and T-

cell-mediated tissue injury. The evidence that TNF-alpha, released by

autoreactive T cells and macrophages, may contribute to the

pathogenesis of immune-mediated demyelinating neuropathies is reviewed.

TNF-alpha antagonists (infliximab, etanercept, adalimumab) are

indicated for the treatment of advanced inflammatory rheumatic and

bowel disease, but these drugs can induce a range of autoimmune

diseases that also attack the central and peripheral nervous systems.

Case histories and series report on the association between anti-TNF-

alpha treatment and various disorders of peripheral nerve such as

Guillain-Barré syndrome, Fisher syndrome, chronic inflammatory

demyelinating polyneuropathy, multifocal motor neuropathy with

conduction block, mononeuropathy multiplex, and axonal sensorimotor

polyneuropathies. The proposed pathogeneses of TNF-alpha-associated

neuropathies include both a T-cell and humoral immune attack against

peripheral nerve myelin, vasculitis-induced nerve ischemia, and

inhibition of signaling support for axons. Most neuropathies improve

over a period of months by withdrawal of the TNF-alpha antagonist, with

or without additional immune-modulating treatment. Preliminary

observations suggest that TNF-alpha antagonists may be useful as an

antigen-nonspecific treatment approach to immune-mediated neuropathies

in patients with a poor response to, or intolerance of, standard

therapies, but further studies are required. PMID: 18041052.

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Thanks, !

[Guest guest]

Thanks, !