Significant recovery of motor function in a patient with complete T7 paraplegia receiving etanercept
Mickaël Dinomais, Laura Stana, Guy Egon, Isabelle Richard, Philippe Menei
Objective: To report an unusual case of significant motor recovery in a patient with T7 complete paraplegia treated with etanercept for ankylosing spondylitis.
Design: Case report.
Results: During the first year sensory-motor recovery occurred, and the American Spinal Injury Association Impairment Scale (AIS) improved from A to D.
Conclusion: Initial spinal cord injury is a direct consequence of the trauma. It triggers a series of molecular and cellular reactions leading to “secondary damage”. Tumour necrosis factor α is a key inflammatory mediator that is increasingly expressed after spinal cord injury. Etanercept is a recombinant dimer of human tumour necrosis factor α receptor protein that inhibits tumour necrosis factor α activity. It has shown an immunomodulatory effect in mice after traumatic spinal cord injury. It significantly reduced the post-¬traumatic spinal cord inflammation and the perilesional area. In this case, a reduction in the secondary damage, due to etanercept treatment could explain the significant motor recovery, which is unusual since 80% of AIS A lesions remain complete.
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