Neurological Toxicity Recognition: ICANS Assessment and Management

Summary for Physicians:

Neurological Toxicity: Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS) Assessment and Management

• ICANS (Immune-Related Neurotoxicity):
• Can range from mild symptoms (eg, confusion, agitation) to severe effects (eg, encephalopathy, seizures).

• Assessment includes evaluating mental status, motor function, speech, and level of consciousness.
• Grading ICANS:
• Grade 1: Mild symptoms, no intervention needed

• Grade 2: Moderate symptoms, requires intervention (eg, corticosteroids)

• Grade 3: Severe symptoms, may need intensive care unit admission and aggressive treatment

• Grade 4: Life-threatening symptoms, requires urgent intervention
• Management:
• Mild (grade 1): Supportive care, close monitoring

• Moderate to severe (grade 2-4):

• Administer steroids (eg, dexamethasone) to manage inflammation.

• For grade 3/4, consider immunosuppressive therapy and intensive neurological monitoring.

• Prompt recognition is critical for preventing progression.

Challenges:

Early detection and rapid intervention are key to minimizing long-term neurological impact.