Review for 10.1186/s12876-021-01780-y (2021)

Reviewer’s report
Title: 
Infliximab-induced seizures in a patient with Crohn's disease : A case
report
Version: 
0 
Date: 
15 Mar 2021
Reviewer's report:
I read with interest this case report, which describes the development of seizure
during induction therapy with infliximab in a patient with Crohn's disease. 
Only few similar cases are reported in the literature and this may represents an
underestimated side effect of anti-TNF. 
However, there are some major concerns that should be resolved:
- English language should be edited: there are several grammatical mistakes, and
case description and discussion are not fluent. 
- please, specify if the patients resulted negative to all screening exams before
starting infliximab (in particular for tuberculosis, given that neurological
involvement of TBC may lead to seizure and liquor examination was not
performed)
- please, specify if calcium and magnesium levels were normal too, among all
blood tests performed. 
- figure 1 is redundant. In its stead, a table including all cases of anti-TNF related
seizures reported so far would add significant value to this manuscript. 
- please, add a further reference: Haddock R et al. JCC 2011; 5(6):623-7.
- in the discussion (line 143-144), the authors stated that "the adverse event can
occur at any stage after IFX use". Do you refer to seizure? In this case, all events
reported so far occurred during the induction phase. So probably such a
conclusion is not justified. Moreover, all cases have no previous neurological
disorder or any risk factor able to predict the new onset of seizure; therefore, it
should be underlined that currently such complication is rare and unpredictable.
And I think there are no data on the effect of anti-TNFs on epileptic patients. On
the other hand, the link between anti-TNF and demyelinating disorders is more
robust, and these conditions represent a clear contraindication to this therapy
since the beginning of anti-TNF history. So the conclusions of the authors seem
to be too much generic (line 148-149): "it is prudent to avoid infliximab in
patients with pre-existing central nervous system disorders". Please, rephrase
your conclusions.
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