so neurotoxicity is basically the manifestations that patients experience
usually with the cytokine release syndrome it usually occurs at the same
time or shortly after and the way to think about it is like a delirium and
probably what is happening is that the information generated by the CAR-T
therapy as it attacks the tumor is affecting the nervous system that's
probably the simplest way to think about it there's a, a spectrum of severity in
neurotoxicity all the way from sort of difficulties with attention difficulties
carrying on a conversation a difficulties expressing expressing
themselves, all the way in severe cases that have been reported but
thankfully we have not experienced of coma and cerebral edema which in its most serious
manifestation could be life-threatening so as far as what a patient would
experience with with neurotoxicity the way that I've had patients describe it
to me is almost like being in a foreign country and not speaking the language so
sort of that kind of disorientation and what their loved ones might notice is
that they have a harder time communicating and they have a harder
time doing things that normally would come become easily first is getting up
going to the restroom writing a sentence attention
difficulties with attention and that's what the clinicians and nurses look for
and that's often what family members will see as well one other thing I
should mention a more concerning thing that we look for and what we're actually
most worried about is when somebody becomes sleepy and they have a hard time
waking up and that's that's more concerning finding but the other
findings are sort of common actually I mean in some sense
expected
so the way that we treat neurotoxicity in the setting of CAR-T therapy is one
we try to reduce systemic inflammation we have a drug that's specifically
targeting interleukin that reduces inflammation so that's one of the first
things that will dry and then in tandem with that we evaluate potential other
causes for confusion because while there can be the neurotoxicity confusion
delirium associated with CAR-T therapy there are also other causes that can
mimic that so we have to do an evaluation to prove indeed that's what's
going on but if that's if that's our conclusion we use the drug to reduce
systemic inflammation as well as steroids and again in extreme cases
we would proceed all the way to potential surgical interventions if
needed we have a dedicated team of neuro-intensivists that would help
one of the things that I think folks should know is that you know we are
concerned about neurotoxicity and so we plan for it and part of that is that you
would meet with myself or one of my colleagues a neurologist to perform
basically a baseline neurologic evaluation so that we understand exactly
who you are and exactly what your neurologic function is and that's
part of our protocol and our standard of care for folks undergoing this therapy I
think just in general
other institutions will have somewhere therapies will have the same drugs we
have but the strength of Mayo Clinic is is the way that we deliver care
you