@article{3209860,
    title = "Demyelinating Disease following Anti-TNFa Treatment: A Causal or Coincidental Association? Report of Four Cases and Review of the Literature.",
    author = "Andreadou, E. and Kemanetzoglou, E. and Brokalaki, Ch and Evangelopoulos, M. E. and Kilidireas, C. and Rombos, A. and Stamboulis, E.",
    journal = "Case Reports in Neurological Medicine",
    year = "2013",
    volume = "2013",
    pages = "671935",
    issn = "2090-6668, 2090-6676",
    doi = "10.1155/2013/671935",
    abstract = "Tumor necrosis factor antagonists (anti-TNFa) are an established therapeutic option for several autoimmune and inflammatory bowel diseases. Despite their clinical  effectiveness, neurological adverse events have been reported and literature data  suggest a potential role of anti-TNFa in the induction of demyelination of the CNS.  We present four patients treated with anti-TNFa who developed symptoms suggestive of  CNS demyelination. The first patient, a 17-year-old male who received etanercept for  psoriatic arthritis for eight months, presented with dysesthesias up to T4 level.  The second patient, a 30-year-old male treated with adalimumab for three years due  to ankylosing spondylitis, presented with right unilateral tinnitus. The third case,  a 47-year-old female, received etanercept for four years because of psoriatic  arthritis and developed persistent headache and left-sided face and head numbness.  Finally, the fourth patient, a 57-years-old female treated with etanercept for six  years due to ankylosing spondylitis, presented with difficulty in speech,  swallowing, and ptosis of the right corner of the mouth. In all cases, brain MRI  showed lesions suggestive of demyelination, while positive oligoclonal bands were  detected in the CSF. Anti-TNFa treatments were discontinued and patients showed  clinical improvement with pulsed intravenous corticosteroid therapy. CNS  demyelination following anti-TNFa treatment represents a relatively rare but  potential serious complication. Close follow-up and MRI monitoring of these patients  is mandatory to elucidate whether the clinical manifestations represent adverse  events occurring during anti-TNFa therapy or a first demyelinating episode."
}