The symptoms of ICANS can vary depending on their grade of severity. Mild symptoms include confusion, headaches, fatigue, and trouble communicating. Severe and potentially life-threatening side effects can include seizures, raised intracranial pressure with cerebral edema (swelling of the brain), and coma.

How are ICANS symptoms classified and treated?

ICANS symptoms can be measured on a grading level from 1-4 to determine their severity.

Grade 1

Patients should be closely monitored and receive supportive measures if needed. Symptoms in Grade 1 include extreme fatigue. Patients at this stage will awaken spontaneously.

Management in this stage includes:

Supportive care
IV hydration
Neurology consultation (bizarre questions asked to assess awareness/consistency)
Imaging tests like EEG (electroencephalogram/brain scan) or MRI (magnetic resonance imaging)
Consider antiepileptic (anti-seizure) drug

Grade 2

Symptoms in Grade 2 include deliriousness or abnormal drowsiness. Patients will only awaken to voices at this stage.

Management reactions in this stage include:

Supportive care included in Grade 1 ICANS management
Consider an ICU transfer
Consider an antiepileptic (anti-seizure) drug, if not already started
Low-dose corticosteroids (i.e. dexamethasone 10mg)

Grade 3

Symptoms in Grade 3 include edema (sweling by fluid buildup) and/or seizures that resolve with intervention. Patients at this stage will only awaken to tactile stimuli.

Management reactions in this stage include:

Supportive care included in Grade 2 ICANS management
An ICU transfer
Continuous corticosteroids (i.e. dexamethasone 10 mg every 6 hours)
Continuous antiepileptic (anti-seizure) drugs
Imaging tests for monitoring

Grade 4

Symptoms in Grade 4 include coma, cerebral edema, life-threatening seizures (>5 minutes), and/or muscle weakness. Patients at this stage are unresponsive.

Management reactions in this stage include:

Supportive care included in Grade 3 ICANS management
High-dose corticosteroids
Specific neurointensive treatment (status epilepticus, brain edema)
Consider further individual treatment