{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:56:35Z","timestamp":1784026595490,"version":"3.55.0"},"reference-count":16,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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\u2013100% by centre) had neurology involvement. Neurology input was associated with younger age (median 67.2 vs. 72.8 years), anatomical location (Central &gt; Peripheral) and severity of neurotoxicity (p &lt; 0.001, q &lt; 0.004). Patients with neurology involvement were more likely to undergo specialist investigations: MR imaging (p = 0.041, q = 0.043), lumbar puncture (p &lt; 0.001, q &lt; 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 \u2264 2), resolution rates were similar in those with or without neurology involvement. At grades 3\u20134, 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.<\/jats:p>","DOI":"10.3390\/cancers17243935","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T12:42:43Z","timestamp":1765284163000},"page":"3935","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Specialist Neurology Involvement and Impact in Immune Checkpoint Inhibitor-Related Neurotoxicity: Experience in a Unified Healthcare System"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5128-569X","authenticated-orcid":false,"given":"Benjamin","family":"Schroeder","sequence":"first","affiliation":[{"name":"Helen Durham Centre for Neuroinflammatory Diseases, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK"},{"name":"Department of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1450-6210","authenticated-orcid":false,"given":"Prakrit","family":"Prasad","sequence":"additional","affiliation":[{"name":"Helen Durham Centre for Neuroinflammatory Diseases, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ope","family":"Gbadegesin","sequence":"additional","affiliation":[{"name":"Helen Durham Centre for Neuroinflammatory Diseases, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senjuti","family":"Gupta","sequence":"additional","affiliation":[{"name":"Velindre Cancer Centre, Velindre Road, Cardiff CF14 2TL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricky","family":"Frazer","sequence":"additional","affiliation":[{"name":"Velindre Cancer Centre, Velindre Road, Cardiff CF14 2TL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smilla","family":"Heaney","sequence":"additional","affiliation":[{"name":"Centre for Cancer Sciences, Translational Medical Sciences, Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5378-6076","authenticated-orcid":false,"given":"Hester","family":"Franks","sequence":"additional","affiliation":[{"name":"Centre for Cancer Sciences, Translational Medical Sciences, Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK"},{"name":"Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Blair","sequence":"additional","affiliation":[{"name":"Somerset Foundation Trust, Musgrove Park Hospital, Parkfield Drive, Taunton, Somerset TA1 5DA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Stuttard","sequence":"additional","affiliation":[{"name":"Somerset Foundation Trust, Musgrove Park Hospital, Parkfield Drive, Taunton, Somerset TA1 5DA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6267-0275","authenticated-orcid":false,"given":"Clare","family":"Barlow","sequence":"additional","affiliation":[{"name":"Somerset Foundation Trust, Musgrove Park Hospital, Parkfield Drive, Taunton, Somerset TA1 5DA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Cook","sequence":"additional","affiliation":[{"name":"The Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Winter","sequence":"additional","affiliation":[{"name":"The Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4792-2953","authenticated-orcid":false,"given":"Paolo","family":"d\u2019Arienzo","sequence":"additional","affiliation":[{"name":"Department of Cancer Services, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4627-7278","authenticated-orcid":false,"given":"Jake","family":"Symington","sequence":"additional","affiliation":[{"name":"Department of Cancer Services, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yassmeen","family":"Radif","sequence":"additional","affiliation":[{"name":"Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanketh","family":"Rampes","sequence":"additional","affiliation":[{"name":"Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Nathan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Cancer Services, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK"},{"name":"University College London Hospitals, 250 Euston Road, London NW1 2BU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisling","family":"Carr","sequence":"additional","affiliation":[{"name":"Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK"},{"name":"Department of Neuromuscular Disease, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Willis","sequence":"additional","affiliation":[{"name":"Helen Durham Centre for Neuroinflammatory Diseases, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK"},{"name":"Department of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11057","DOI":"10.1200\/JCO.2024.42.16_suppl.11057","article-title":"Overlapping and non-overlapping indications for checkpoint inhibitors in the US","volume":"42","author":"Paul","year":"2024","journal-title":"J. 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