Perispinal Etanercept for Traumatic Brain Injury

“Perispinal Etanercept for Traumatic Brain Injury” is Chapter 7 of the medical textbook New Therapeutics for Traumatic Brain Injury. See the abstract and links below:

“Abstract
Brain dysfunction after traumatic brain injury (TBI) may involve a persistent neuroinflammatory response that can last for years following acute brain insult. This neuroinflammatory response may include microglial activation and persistence of excess levels of tumor necrosis factor (TNF) in the brain, resulting in perturbation of brain function. TNF, in addition to its role as the master regulator of the inflammatory response, is a key regulator of synaptic function in the brain. Experimental data suggest that etanercept, a selective TNF inhibitor, may ameliorate microglial activation; modulate the adverse synaptic effects of excess TNF; and favorably intervene in basic science models of TBI, stroke, subarachnoid hemorrhage, and Alzheimer’s disease. Perispinal administration is a therapeutic method designed to use the cerebrospinal venous system to enhance selective delivery of etanercept across the blood–cerebrospinal fluid barrier. Increasing clinical data suggests that perispinal etanercept (PSE) has therapeutic utility for treatment of selected brain disorders associated with elevated TNF, including chronic neurological dysfunction following stroke and various forms of brain injury. PSE is an emerging treatment modality for TBI.”

Rapid Improvement in Gait 8 years after Severe Traumatic Brain Injury at the INR, March 2017

Traumatic Brain Injury 8 years prior, gait improvement after treatment at the INR in Boca Raton in March 2017.

Disclaimer: Individual results vary, not all patients respond. Additional doses may be necessary to maintain the clinical response. Treatment for these indications is innovative (“off-label”). Please see the Terms of Use. The method of off-label treatment utilized is a patented invention of the INR. Copyright 2017 INR PLLC, all rights reserved.


Scientific literature provides support for the scientific rationale. See:

Perispinal Delivery of CNS Drugs

Perispinal.Delivery.coverMay 2, 2016 (Los Angeles, Boca Raton): On April 27, 2016, the peer-reviewed review article entitled, Perispinal Delivery of CNS Drugs, by Edward Tobinick MD, published online in the scientific journal CNS Drugs. The article published in print in the June issue of the journal. The abstract of the article states:

Perispinal injection is a novel emerging method of drug delivery to the central nervous system (CNS). Physiological barriers prevent macromolecules from efficiently penetrating into the CNS after systemic administration. Perispinal injection is designed to use the cerebrospinal venous system (CSVS) to enhance delivery of drugs to the CNS. It delivers a substance into the anatomic area posterior to the ligamentum flavum, an anatomic region drained by the external vertebral venous plexus (EVVP), a division of the CSVS. Blood within the EVVP communicates with the deeper venous plexuses of the CSVS. The anatomical basis for this method originates in the detailed studies of the CSVS published in 1819 by the French anatomist Gilbert Breschet. By the turn of the century, Breschet’s findings were nearly forgotten, until rediscovered by American anatomist Oscar Batson in 1940. Batson confirmed the unique, linear, bidirectional and retrograde flow of blood between the spinal and cerebral divisions of the CSVS, made possible by the absence of venous valves. Recently, additional supporting evidence was discovered in the publications of American neurologist Corning. Analysis suggests that Corning’s famous first use of cocaine for spinal anesthesia in 1885 was in fact based on Breschet’s anatomical findings, and accomplished by perispinal injection. The therapeutic potential of perispinal injection for CNS disorders is highlighted by the rapid neurological improvement in patients with otherwise intractable neuroinflammatory disorders that may ensue following perispinal etanercept administration. Perispinal delivery merits intense investigation as a new method of enhanced delivery of macromolecules to the CNS and related structures.

Note added in July 2016: A related article, entitled “Perispinal Delivery of CNS Drugs: From Corning to Perispinal Etanercept”, published on July 9, 2016, on the Brain Immune Trends website, accessible by clicking here.

The full-text of the article is available by clicking on the link below:

Perispinal Delivery of CNS DrugsEdward Tobinick MD. CNS Drugs. 2016;30(6):469-80. do:10.1007/s40263-016-0339-2, published online 27 April 2016. (Download free full-text PDF).