Neurological irAEs are reported less frequently in patients receiving ICIs (1%-12%) and tend to present as low grade (1-2) within the first 3 months of starting immunotherapy. irAEs associated with the peripheral nervous system (PNS) are more common than the central nervous system (CNS), with peripheral neuropathy and myasthenia gravis being the most common. Multiple irAEs associated with neuromuscular disorders can occur simultaneously in patients taking immunotherapy, often with overlapping symptoms not often seen in the general population. Patients often present with non-specific symptoms including headache or dizziness, though more serious events (grade 3-4) occur in less than 1% of patients, with encephalitis and myasthenia gravis proving to be the most fatal. Clinical assessment includes serum testing, diagnostic imaging, respiratory function assessment, rule out other underlying conditions, potential lumbar puncture and consultation with a neurologist. Immunotherapy should be held and potentially stopped should a patient experience a grade 2 or higher neurological irAE. While no standard treatment has been established for treating neurological irAEs, immune-modulating therapy such as corticosteroids and discontinuation of ICI therapy have shown improvement in some cases.
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