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What causes confusion, imbalance issues and poor motor skills after having Humira?

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Posted on Fri, 15 May 2015
Question: Hi I've had two episodes after I've taken Humira where I develop confusion, unsteady balance, problems with fine motor skills, double and blurred vision, hoarse and stecaato speech, trouble swallowing, muscle weakness and spasms, bradykinesia, headache, eyelid droop, facial weakness, difficulty with word finding and about 2 to 3 days of confusion. The symptoms are strokelike. They last about two weeks. Symptoms begin with the week of Humira and are more mild in between treatments. These sxS are difficulty testing, memory issues and fatigue. I don't take my Humira every two weeks. I was hospitalized with each reaction. mri/mra and ct negative. MYathenia gravis testing was negative. They did not do an emg or immune work up. What is your differential for these symptoms and what tests should would you rec? This definitely correlates with Humira injections and I am wondering what could Humira unmask or even cause? Thank u.
Can seizure disorder cause the symptoms that I've described? I'm 39- can seizures develop this late? Would EEG be the test of choice? Thank you
doctor
Answered by Dr. Dariush Saghafi (17 hours later)
Brief Answer:
Yes, definitely can produce at least some of the symptoms you mention

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a neurologist from XXXXXXX Ohio. I have had several patients with your symptomatology after receiving Humira injections.

Some of the more common neurological symptoms that can occur include:

Confusion, numbness/tingling, subdural hematoma (collection of blood under the skull cap), and tremors

As it is a biological agent it can also cause reactions of an autoimmune type that can cause DEMYELINATION which means that symptoms can at times seem strokelike and could look like the following:

new onset or exacerbation of clinical symptoms and/or radiographic evidence of central nervous system demyelinating disease, including multiple sclerosis (MS) and optic neuritis, and peripheral demyelinating disease, including Guillain-Barré syndrome.

Both MS and GBS can look stroke-like due to sudden onset of weakness or sensory symptoms.

In the several patients we've treated and seen reactions the duration of symptoms ranged from about 3-10 days. We also needed to do a full blown workup on these patients to rule out actual stroke or GBS.

So long as the workup done takes into consideration things such as stroke, GBS, MG, and demyelinating disease then, you will have had the bases covered in terms of being sure that nothing actually happened.

However, do you really want to go through these symptoms every time you get an injection? And yes, possible unmasking of some very serious and nasty complications is possible. On all the patients who suffered the symptoms (some of which you mentioned) I recommended they no longer take the injections. I don't think that those side effects are worth the risk of having some really full blown reactions of demyelination because you never know which one of those times it's going to be permanent and irreversible. Then, you're in real trouble.

If you would like to know what it can cause or unmask go to:

http://www.rxabbvie.com/pdf/humira.pdf

and then, ask yourself WHO REALLY GETS BENEFITS FROM THIS DRUG???!!!

Yes, seizure disorder can cause something called a TODD'S PARALYSIS which is when there are stroke-like symptoms but in the face of injecting Humira I would keep that medication as the most likely culprit while still doing all the rest of the workup as appropriate to the situation.

Yes, 39 years olds can develop spontaneous seizures. I've got 80+ people developing seizure disorders out of the blue.....let alone spring chickens of 39!

;)

I hope these answers satisfactorily address your questions as a whole. I would greatly appreciate a HIGH STAR RATING with some written feedback on what I've documented for you to this point.

Also, may I ask that if there are no further questions or comments that you CLOSE THE QUERY so that the response can be transacted and archived for further reference by colleagues as necessary?

Of course, if you do have an additional question or 2 I'm very happy to answer them so please send them to my attention just as soon as possible.

Please do keep me informed ultimately as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 35 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (3 minutes later)
How would basilar artery hyperdensity at tip on ct and mri/mra eith acute stoke like sxs and residual deficits fit this picture
doctor
Answered by Dr. Dariush Saghafi (18 minutes later)
Brief Answer:
I believe in your first message you said that CT/MRI/MRA were negativ

Detailed Answer:
Hello....well, I guess the short answer would be that what you're saying DOESN'T REALLY seem to fit based upon the fact that in your first message to me you essentially ruled out stroke (at least in the territory of the Basilar artery and/or PCA territories). And so, your follow-up question is a bit confusing. Are you saying that someone went back and reread the scans to now FIND a basilar HYPERDENSITY at the TOP (we don't really say "tip") of the basilar? Can you be specific as to what the MRI and MRA showed? Stroke protocols nowadays include diffusion/perfusion tensor weighted studies which tell us what the permeability factors of the vasculature are in the areas of the stroke. Do you have that information by chance?

If there were a TOP OF THE BASILAR stroke then, virtually all the symptoms you mentioned including an electrical seizure could follow.

However, if it were a full blown Top of the Basilar event- things would be more devastating in my opinion since also PCA perfusion would likely be affected and this would give you all sorts of visual phenomenon and visual field defects of a region nature. Of course, you are reporting double vision but there likely would be full field affectation since both PCA's may be affected in the bilateral occipital lobes. You'd not be a happy camper AT ALL! You're not referring anything like that in your clinical recounting of what happened.

If these next set of answers satisfactorily address your questions then, I would greatly appreciate a HIGH STAR RATING with some written feedback.

Also, if there are no further questions or comments could you please CLOSE THE QUERY so that the thread can be transacted and archived for further reference by colleagues as necessary?

Of course, if you do have an additional question or 2. I'm very happy to answer them if sent to my attention just as soon as possible.

Please do keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (9 minutes later)
Yes i have double vision, and flippedand totaled my car into a tree 2 driveways from house. I have speach troubles and jumbled words like apaphasia still and left sided weakness head to toe. Im going to attach mri and ct
also, the workup's that you have described have not been done because no one is taking me seriously. A friend is doing me a favor and getting me in to see Rheum.
Would there be any other tests that haven't been done that you would recommend to rule out stroke?
doctor
Answered by Dr. Dariush Saghafi (21 hours later)
Brief Answer:
Working up a stroke

Detailed Answer:
I believe that the story you tell in terms of its relationship to the injection of Humira should be looked at as very possibly related if for nothing else because of the 2 times you've taken the injection followed by the symptoms you've mentioned.

The workup for a stroke really should be as I stated above but I will repeat for clarity:

1. MRI of the head using diffusion/perfusion weighted imaging
2. MRA of the head and neck
3. Blood work: cbc/diff, PT, PTT, Thrombin, fibrin, fibrin split products, d-dimer, Lupus anticoagulant, Factor V Leiden
4. Transesophageal Echocardiogram (TEE)
5. 2D echo with bubble study (evaluation for potential PFO)


If this workup is completely negative (and apparently some of this has already been done) then, I would strongly suspect the Humira as being involved in the symptoms you are displaying.

In your case the MRI and MRA studies by report are negative. Also, do not concern yourself with the CT finding of calcification of the tip of the basilar because that is probably just an artifact (not clinically significant) since the MRI/MRA studies did not see anything there. MR studies are at least 10x more sensitive to vascular occlusions and problems than CT scans are therefore, if the MRI/MRA doesn't see a calcification in the basilar artery then, it ain't there! ;)

I hope these answers satisfactorily address your questions as a whole. I would greatly appreciate a HIGH STAR RATING with some written feedback on what I've documented for you to this point.

Also, may I ask that you rate the answers to this point and CLOSE THE QUERY so that this event maybe be transacted and archived for further reference by colleagues as necessary?

You may certainly reopen this conversation under a new set of questions if you like.

Please do keep me informed ultimately as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 73 minutes of physician specific time to read, research, and compile a return envoy to the patient.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

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What causes confusion, imbalance issues and poor motor skills after having Humira?

Brief Answer: Yes, definitely can produce at least some of the symptoms you mention Detailed Answer: Good evening. My name is Dr. Saghafi and I am a neurologist from XXXXXXX Ohio. I have had several patients with your symptomatology after receiving Humira injections. Some of the more common neurological symptoms that can occur include: Confusion, numbness/tingling, subdural hematoma (collection of blood under the skull cap), and tremors As it is a biological agent it can also cause reactions of an autoimmune type that can cause DEMYELINATION which means that symptoms can at times seem strokelike and could look like the following: new onset or exacerbation of clinical symptoms and/or radiographic evidence of central nervous system demyelinating disease, including multiple sclerosis (MS) and optic neuritis, and peripheral demyelinating disease, including Guillain-Barré syndrome. Both MS and GBS can look stroke-like due to sudden onset of weakness or sensory symptoms. In the several patients we've treated and seen reactions the duration of symptoms ranged from about 3-10 days. We also needed to do a full blown workup on these patients to rule out actual stroke or GBS. So long as the workup done takes into consideration things such as stroke, GBS, MG, and demyelinating disease then, you will have had the bases covered in terms of being sure that nothing actually happened. However, do you really want to go through these symptoms every time you get an injection? And yes, possible unmasking of some very serious and nasty complications is possible. On all the patients who suffered the symptoms (some of which you mentioned) I recommended they no longer take the injections. I don't think that those side effects are worth the risk of having some really full blown reactions of demyelination because you never know which one of those times it's going to be permanent and irreversible. Then, you're in real trouble. If you would like to know what it can cause or unmask go to: http://www.rxabbvie.com/pdf/humira.pdf and then, ask yourself WHO REALLY GETS BENEFITS FROM THIS DRUG???!!! Yes, seizure disorder can cause something called a TODD'S PARALYSIS which is when there are stroke-like symptoms but in the face of injecting Humira I would keep that medication as the most likely culprit while still doing all the rest of the workup as appropriate to the situation. Yes, 39 years olds can develop spontaneous seizures. I've got 80+ people developing seizure disorders out of the blue.....let alone spring chickens of 39! ;) I hope these answers satisfactorily address your questions as a whole. I would greatly appreciate a HIGH STAR RATING with some written feedback on what I've documented for you to this point. Also, may I ask that if there are no further questions or comments that you CLOSE THE QUERY so that the response can be transacted and archived for further reference by colleagues as necessary? Of course, if you do have an additional question or 2 I'm very happy to answer them so please send them to my attention just as soon as possible. Please do keep me informed ultimately as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi All the best. The query has required a total of 35 minutes of physician specific time to read, research, and compile a return envoy to the patient.