Background: Neurological immune related adverse events (N-irAEs) following immune checkpoint inhibitor (ICI) therapy are associated with significant morbidity and mortality. The early involvement of neurological services is therefore recommended to assist diagnosis and guide management. However, the practical experience of specialist neurology involvement is poorly understood. Methods: A multi-centre, retrospective case note review was performed in a unified healthcare setting in the United Kingdom via predetermined proforma to investigate the involvement and impact of neurology services in this setting. Results: One hundred and nine patients with N-irAE were identified with a median time from ICI treatment to symptom onset of 52 days. Neurology service models, reasons for referral and referral rates varied by centre. Overall, eighty-seven (79.8%) patients (range 52.9–100% by centre) had neurology involvement. Neurology input was associated with younger age (median 67.2 vs. 72.8 years), anatomical location (Central > Peripheral) and severity of neurotoxicity (p< 0.001, q < 0.004). Patients with neurology involvement were more likely to undergo specialist investigations: MR imaging (p= 0.041, q = 0.043), lumbar puncture (p< 0.001, q < 0.004), and neurophysiology (p= 0.005, q = 0.007) resulting in a broader range of specific N-irAE diagnoses. Steroids were appropriately prescribed, with second line treatment (Intravenous immunoglobulins/Plasma exchange) associated with neurology involvement. At lower grades (CTCAE ≤ 2), resolution rates were similar in those with or without neurology involvement. At grades 3–4, one-third of patients with neurology involvement had resolution. In a centre with a model of early neurology involvement for all possible N-irAEs the aetiology of the neurological presentation was changed in 63.7%. Conclusions: This study highlights the potential to improve diagnosis and treatment algorithms and therefore patient outcomes through development of uniform N-irAE models of care to support this area of growing clinical need.
背景：免疫检查点抑制剂（ICI）治疗后出现的神经免疫相关不良事件（N-irAEs）与显著的发病率和死亡率相关。因此建议早期引入神经专科服务以协助诊断并指导治疗。然而，目前对神经专科参与的实际经验了解甚少。方法：在英国统一医疗体系内通过预设表格进行多中心回顾性病例记录审查，以探究神经专科服务在此背景下的参与情况及影响。结果：共识别出109例N-irAEs患者，从ICI治疗到症状出现的中位时间为52天。各中心的神经专科服务模式、转诊原因及转诊率存在差异。总体而言，87例（79.8%）患者（各中心范围52.9%-100%）接受了神经专科介入。神经专科介入与较低年龄（中位数67.2岁 vs 72.8岁）、解剖部位（中枢>外周）及神经毒性严重程度相关（p<0.001，q<0.004）。接受神经专科介入的患者更可能接受专项检查：磁共振成像（p=0.041，q=0.043）、腰椎穿刺（p<0.001，q<0.004）和神经电生理检查（p=0.005，q=0.007），从而获得更广泛的特定N-irAEs诊断。类固醇药物使用适当，二线治疗（静脉注射免疫球蛋白/血浆置换）与神经专科介入相关。在较低分级（CTCAE≤2级）中，无论是否接受神经专科介入，症状缓解率相似。在3-4级患者中，接受神经专科介入者三分之一获得症状缓解。在实施早期神经专科介入模式的中心，63.7%患者的神经症状病因诊断发生改变。结论：本研究强调通过建立统一的N-irAEs诊疗模式，有望优化诊断与治疗路径，从而改善患者预后，以应对这一日益增长的临床需求领域。
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