TABLE 4.
Other treatment recommendations for suspected immune-related neurological syndromes
| Suspected syndrome | Treatment recommendations |
|---|---|
| Central neurological toxicity | |
| Aseptic meningitis | Consider concurrent empiric antiviral (i.v. acyclovir) and antibacterial therapy |
| Encephalitis | Consider concurrent empiric antiviral (i.v. acyclovir) |
| Transverse myelitis | Start 2 mg kg−1 day−1 (methyl)prednisolone or 1 g/day |
| If no improvement or worsening, consider plasmapheresis | |
| Peripheral neurological toxicity | |
| Guillain–Barré syndrome (GBS) | Consider 1–2 mg kg−1 day−1 prednisolone equivalents PO or IV |
| If no improvement or worsening, plasmapheresis or intravenous immunoglobulin indicated | |
| • Ventilatory support should be available | |
| • Steroids not recommended for idiopathic GBS | |
| Myasthenia Gravis | Steroid indicated—dosing according with grading of symptoms |
| Pyridostigmine, initial dose of 30 mg | |
| If no improvement or worsening, consider plasmapheresis or intravenous immunoglobulin, additional immunosuppressants azathioprine, cyclosporine, or mycophenolate | |
| *Avoid medications that may precipitate cholinergic crisis | |