{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T16:44:47Z","timestamp":1782751487391,"version":"3.54.5"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>The use of chimeric antigen receptor T-cell (CAR-T) therapy has become more widespread in recent years, most commonly for hematologic malignancies. This therapy can be potentially associated with neurotoxic side effects. We present a patient with refractory multiple myeloma who developed diplopia, bilateral upward gaze limitation, abducens palsy, bilateral facial nerve palsy, and thoracic sensory radiculopathy following a course of CAR-T therapy, which were suspected to represent delayed immune effector cell-associated nerve palsies (IEC-NPs). His symptoms progressed despite oral and intravenous steroids. Subsequent intrathecal methotrexate and systemic cyclophosphamide resulted in acute symptomatic improvement and eventual resolution of diplopia and gradual recovery of extraocular movements and facial nerve palsies.<\/jats:p>","DOI":"10.3389\/fneur.2026.1835346","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:55:24Z","timestamp":1782748524000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Steroid-resistant bilateral facial nerve palsies, ophthalmoparesis, and multilevel thoracic radiculopathy as immune effector cell-associated late-onset neurotoxicity after cilta-cel CAR-T therapy: a case report and review of similar cases"],"prefix":"10.3389","volume":"17","author":[{"given":"James Reid","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Neurology, School of Medicine, University of Louisville","place":["Louisville, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Gupta","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Louisville","place":["Louisville, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Tavcar","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville","place":["Louisville, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Glynn","sequence":"additional","affiliation":[{"name":"Kornhauser Health Sciences Library, University of Louisville","place":["Louisville, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hedera","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine, University of Louisville","place":["Louisville, KY, United 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(S16.006)","volume":"104","author":"Miller","year":"2025","journal-title":"Neurology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e203","DOI":"10.1016\/S1470-2045(24)00715-0","article-title":"Non-ICANS neurological complications after CAR T-cell therapies: recommendations from the EBMT practice harmonisation and guidelines committee","volume":"26","author":"Graham","year":"2025","journal-title":"Lancet Oncol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"S503","DOI":"10.1016\/j.jtct.2025.01.801","article-title":"Orthopnea from phrenic nerve palsy after ciltacabtagene autoleucel CAR-T in a patient with multiple myeloma","volume":"31","author":"Fitzgerald","year":"2025","journal-title":"Transplant Cell Ther"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1038\/S41408-025-01441-3","article-title":"Clinical course, risk factors and mitigating strategies for immune effector cell-associated late onset neurotoxicities after ciltacabtagene autoleucel CAR-T in multiple myeloma","volume":"16","author":"Lim","year":"2025","journal-title":"Blood Cancer J"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1038\/s41591-021-01564-7","article-title":"Neurocognitive and hypokinetic movement disorder with features of parkinsonism after BCMA-targeting CAR-T cell therapy","volume":"27","author":"Van Oekelen","year":"2021","journal-title":"Nat Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1182\/BLOODADVANCES.2020001626","article-title":"Intrathecal chemotherapy for management of steroid-refractory CAR T-cell-associated neurotoxicity syndrome","volume":"4","author":"Shah","year":"2020","journal-title":"Blood Adv"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1001\/JAMAONCOL.2022.0070","article-title":"Use of early intrathecal therapy to manage high-grade immune effector cell-associated neurotoxicity 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