Neurological Effects Associated with CAR T-Cell Therapy
Neurological side effects are a distinct and clinically important complication of CAR T-cell therapy. Often referred to as immune effector cell–associated neurotoxicity syndrome (ICANS), these effects result from immune activation and inflammation within the central nervous system. Although usually temporary, neurological symptoms require vigilant monitoring and prompt management.
Neurological symptoms can occur independently or alongside cytokine release syndrome. Common early manifestations include headache, confusion, difficulty speaking, tremors, and impaired attention. In more severe cases, patients may experience seizures, decreased consciousness, or cerebral edema.
The exact mechanisms underlying CAR T-cell–related neurotoxicity are still being studied. Current evidence suggests that inflammatory cytokines disrupt the blood-brain barrier, allowing immune mediators to affect brain tissue. High disease burden and severe CRS are associated with increased risk.
Assessment begins with baseline neurological evaluation prior to CAR T-cell infusion. After treatment, patients undergo regular neurological checks using standardized assessment tools. Early detection allows intervention before symptoms progress.
Management of neurotoxicity focuses on supportive care and symptom control. This may include anti-seizure medications, corticosteroids, and intensive monitoring in severe cases. Most neurological symptoms resolve with appropriate treatment, and long-term neurological impairment is uncommon.
Patient and caregiver education is critical. Awareness of early symptoms ensures rapid reporting and timely intervention. Multidisciplinary coordination among oncologists, neurologists, and critical care specialists improves outcomes.