This article is intended for healthcare professionals seeking a deeper understanding of the biological mechanism, indications, and administration practices behind the Re-Mind treatment. Links to scientific articles and further reading are provided at the end.
Introduction to the Re-Mind treatment
Re-Mind is a specialised treatment for patients with persistent neurological and cognitive sequelae following acquired brain injury, including concussion, traumatic brain injury (TBI), stroke, and certain long-term effects of COVID-19.
The Re-Mind treatment uses targeted inhibition of tumour necrosis factor alpha (TNF-α) with the medicine Etanercept (Enbrel®), administered through a modified perispinal subcutaneous technique. The aim is to reduce chronic TNF-α-driven neuroinflammation in the brains of patients whose symptoms persist long after the initial brain injury.
The treatment is an off-label use of Etanercept. All patients receive thorough information and provide written informed consent before treatment.
Background: Persistent BBB dysfunction and neuroinflammation
The blood-brain barrier (BBB) has traditionally been considered a structure affected primarily during the acute phase after a brain injury. However, recent research and advanced imaging techniques, including DCE-MRI, show that the BBB may remain permeable for months or years following:
- Concussion (commotio cerebri)
- Traumatic brain injury (TBI)
- Stroke (ischaemic and haemorrhagic)
- Long-term effects of COVID-19
This persistent BBB permeability is closely associated with a chronic, self-perpetuating inflammatory cycle driven by the cytokine TNF-α. Chronically elevated TNF-α in the central nervous system (CNS) disrupts synaptic plasticity, neurotransmission, and neuronal network integration. This may explain the persistent cognitive and neurological sequelae experienced by many patients.
Read more about BBB dysfunction and neuroinflammation
Mechanism of action: TNF-α as a therapeutic target
The combination of persistent BBB dysfunction and TNF-α-driven neuroinflammation is the primary therapeutic target of the Re-Mind treatment.
The treatment uses Etanercept (Enbrel), a human TNF inhibitor. By neutralising both soluble and membrane-bound TNF-α, the treatment aims to:
- Reduce BBB permeability
- Reduce microglial activation
- Restore normal synaptic function and neurotransmission
Administration: Perispinal delivery
To achieve an effect in the central nervous system, a specific administration method is used that differs from the systemic treatment of rheumatological disorders:
- Injection method: Etanercept is administered as a subcutaneous injection near the perispinal veins.
- Anatomical transport: The method uses the vertebral venous plexus (Batson’s plexus) and the meningeal lymphatic pathways, which permit bidirectional flow.
- Trendelenburg position: Immediately after the injection, the patient is placed in the Trendelenburg position to increase pressure towards the BBB tight junctions and the choroid plexus and promote transport of the medicine to the brain.
Many patients report a clinical response within hours or a few days. This supports the theory of a direct effect on synaptic regulation rather than structural healing alone.
Etanercept reaches the brain through the glymphatic system, the meningeal lymphatic vessels, and the choroid plexus, where it enters the cerebrospinal fluid and neutralises TNF-α.
Read more about Etanercept’s pathway and mechanism of action in the CNS
Clinical outcomes and patient safety
At RN Clinics, more than 200 patients have been treated with perispinal Etanercept. Approximately 185 of these patients have experienced clinically relevant improvements in areas including:
- Pain reduction
- Mental clarity
- Improved reaction times
- Improved cognition
- Reduced fatigue
- Improved sleep quality
- Reduced headaches
- Improved sensory function
- Emotional stability
- Reduced spasticity
- Improved mobility
Pre-treatment testing and safety
Before treatment, patients undergo a mandatory specialist assessment, a review of their discharge summary, and screening blood tests. Testing includes latent tuberculosis, chronic hepatitis, and standard organ markers, corresponding to the usual preparation before biological treatment.
Because the Re-Mind treatment often consists of only one or two individual doses, it does not have the same risk profile as long-term weekly administration. The most common adverse effects are mild and include redness or itching at the injection site, a temporary sensation of fever without an actual fever, and a transient headache, typically lasting one day.
Download the article with references as a PDF
Contact
If you are a doctor with questions about the evidence base or would like to refer a patient, please contact the clinic by telephone at +45 88 44 88 60 or email info@rnklinik.dk.
Further reading
- Patient statistics
- Article about Re-Mind from Hjernesagen, issue 1, 2026
- Fact sheet for general practitioners
- Background: Persistent BBB dysfunction following brain injury
- Scientific articles about the treatment
Source: RN Clinics’ medical information about the Re-Mind treatment.
