Positives

• A severe long COVID patient in a published case report described rapid improvement in cognitive dysfunction, fatigue, and depression after a single perispinal etanercept dose PubMed.
  
  
• A post-stroke patient reported sustained relief from previously intractable central pain eleven months after a single 25 mg perispinal injection Springer.
  
  

Negatives

• A randomized controlled trial in stroke patients showed no improvement in quality of life 28 days after perispinal etanercept, tempering long COVID expectations Neurology.
  
  
• Forum members raised concerns about systemic immunosuppression and infection risk inherent to TNF blockade Science for ME.
  
  

Hurdles & Side Effects

• Patients reported the off-label perispinal route is offered by only a small number of clinicians, requiring travel and out-of-pocket payment Drugs.com.
  
  
• Reviewers flagged that insurance does not cover the unapproved indication, leaving costs of thousands per dose to the patient AMMES.