Journal of Inflammatory Bowel Diseases & Disorders

CNS Demyelination under anti-TNF Medication; Coincidence or causal?

Abstract

Hauke C. Tews, Annik Lundie, Paul L. Tiemann, Christian Sina, Carlos Maa�?, Philipp C. Solbach, Julia Graf, Thomas F. Münte and Jens U. Marquardt

We describe the case of a 40-year-old patient with active Crohn’s Disease (CD)-who developed neurological symptoms and was subsequently diagnosed with cerebral demyelination shortly after re-exposure to a therapy with Adalimumab. Based on the current state of scientific knowledge, we here discuss whether concurrent diagnosis of demyelinating disease and the anti-tumor-necrosis-factor (TNF)-alpha-therapy develop independently or whether direct causality is more likely. Basis for this purpose are the diseases´ incidence rates and the different pathophysiological hypotheses for demyelination under anti-TNF-alpha-therapy. Due to high incidence of cerebral demyelination and lack of laboratory or clinical markers to differentiate the underlying influences, a definite conclusion cannot be drawn. Based on the presented findings and state of the literature, we finally deduce recommendations for clinical practice and research gaps.