View source for Immune effector cell-associated neurotoxicity syndrome

== Background ==

* Adverse effect of [[CAR-T]] and [[BiTE]] therapies

== Clinical Manifestations ==

* Encephalopathy, delirium, confusion, disorientation
* Seizures
* Aphasia or dysphasia
* Tremor, ataxia
* Dyscalculia
* Headache

== ASTCT ICANS Grading[[CiteRef::lee2019as]] ==
{| class="wikitable"
!Domain
!Grade 1
!Grade 2
!Grade 3
!Grade 4
|-
|ICE score
|7-9
|3-6
|0-2
|Unarousable
|-
|Level of consciousness
|Awakens spontaneously
|Awakens to voice
|Awakens to tactile stimulus
|Unarousable, stupor, coma, or requires vigorous or repetitive tactile stimuli
|-
|Seizure
|—
|—
|Any that resolves rapidly, or nonconvulsive seizure on EEG that resolves with intervention
|Life-threatening seizure >5 min or [[status epilepticus]]
|-
|Motor findings
|—
|—
|—
|Deep focal motor weakness, such as hemiparesis or paraparesis
|-
|ICP/cerebral edema
|—
|—
|Focal or local edema on neuroimaging
|Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing;[[cranial nerve VI palsy]]; [[papilledema]]; or [[Cushing triad]]
|}

=== ICE Assessment Tool ===
{| class="wikitable"
!Domain
!Description
!Points
|-
|Orientation
|orientation to year, month, city, and hospital
|4
|-
|Naming
|ability to name 3 objects (e.g. point to clock, pen, button)
|3
|-
|Following commands
|ability to follow simple commands (e.g. "Show me 2 fingers", "Close you eyes and stick out your tongue"
|1
|-
|Writing
|ability to write a standard sentence (e.g. "Our national bird is the bald eagle")
|1
|-
|Attention
|ability to count backwards from 100 by 10
|1
|}

== Management ==

* High-dose steroids, depending on grading

[[Category:Hematology]]
[[Category:Oncology]]
[[Category:Neurology]]
[[Category:Adverse drug reactions]]