Demyelinating disorders can also be a rare complication of anti-TNF-О± therapy.

Anti-TNF-О± therapy is contraindicated in the treatment of patients who have both IBD and multiple sclerosis. There is a bidirectional association between multiple sclerosis and IBD, with a relative risk for comorbidity of 1.54, being 1.53 for the risk of multiple sclerosis in IBD and 1.55 for the risk of IBD in multiple sclerosis patients. Patients with IBD have an increased risk of arterial and venous stroke, mainly during periods of exacerbations. The pathophysiology of neurological manifestations of IBD is mostly immune mediated, but dysfunction of the brain-gut axis, arterial and venous thromboembolism, infections, nutritional deficiencies and side-effects of medications (steroids, metronidazole, sulfasalazine, anti-TNF-О±, anti-integrin antibodies) are other contributory mechanisms. The incidence of neurological complications in IBD ranges from 0.25% to 47.5%. Besides gastrointestinal manifestations, IBD causes extraintestinal manifestations in the central and peripheral nervous system.

Inflammatory bowel diseases (IBD) are chronic inflammatory conditions affecting the digestive system, comprising two main distinctive entities, ulcerative colitis (UC) and Crohn's disease (CD).

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