Immune-Related Neuromuscular Complications of Checkpoint Inhibitors

Purpose of Review Immune checkpoint inhibition for treatment of metastatic cancers is recognized to cause diverse immune-mediated neurological syndromes. This review will discuss current knowledge about the frequency and varied presentation of these syndromes affecting the peripheral nervous system as well as detail important diagnostic and management considerations. Recent Findings Immune-related adverse events affect the peripheral nervous system more often than the central nervous system, and rates are likely underestimated. Most data regarding neurological immune–related adverse events are retrospective, and prospective studies are needed. These immune-mediated peripheral nervous system syndromes can be severe and contribute to mortality. Discontinuation of ICI therapy combined with aggressive medical management can improve outcomes. Data to inform evidence-based treatment approaches, particularly in moderate to severe events, are needed. Summary It is important to recognize the association between immune-mediated peripheral nervous system syndromes and immune checkpoint therapy. These syndromes can be phenotypically diverse, but conditions such as acquired demyelinating neuropathy, myositis, and myasthenia gravis predominate. It is important for neurologists to recognize and promptly diagnose these conditions and manage these patients in a multidisciplinary setting to improve outcomes.