1
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Darwesh KM. Paraneoplastic Syndrome Case Presented As Nystagmus and Ataxia. Cureus 2024; 16:e55153. [PMID: 38558653 PMCID: PMC10980271 DOI: 10.7759/cureus.55153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
The incidence of paraneoplastic syndrome (PNS) is on the rise, attributed to the growing detection of antibody modalities in both the serum and cerebrospinal fluid (CSF). PNS can occur as different neurological symptoms. The revised guidelines streamline the diagnostic approach but identifying PNS still requires the detection of neurological manifestations concurrent with cancer, along with the presence of specific PNS autoantibodies.
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2
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Kadish R, Clardy SL. Epidemiology of paraneoplastic neurologic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:57-77. [PMID: 38494297 DOI: 10.1016/b978-0-12-823912-4.00011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes (PNS), initially depicted as seemingly cryptic remote manifestations of malignancy, were first described clinically in the early 20th century, with pathophysiologic correlates becoming better elucidated in the latter half of the century. There remain many questions not only about the pathophysiology but also regarding the epidemiology of these conditions. The continuous discovery of novel autoantigens and related neurologic disease has broadened the association in classical PNS to include conditions such as paraneoplastic cerebellar degeneration. It has also brought into focus several other neurologic syndromes with a putative neoplastic association. These conditions are overall rare, making it difficult to capture large numbers of patients to study, and raising the question of whether incidence is increasing over time or improved identification is driving the increased numbers of cases. With the rise and increasing use of immunotherapy for cancer treatment, the incidence of these conditions is additionally expected to rise and may present with various clinical symptoms. As we enter an era of clinical trial intervention in these conditions, much work is needed to capture more granular data on population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, and gender to optimize care and clinical trial planning.
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Affiliation(s)
- Robert Kadish
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, United States; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States.
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3
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Chiu D, Rhee J, Gonzalez Castro LN. Diagnosis and Treatment of Paraneoplastic Neurologic Syndromes. Antibodies (Basel) 2023; 12:50. [PMID: 37606434 PMCID: PMC10443237 DOI: 10.3390/antib12030050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Paraneoplastic antibody syndromes result from the anti-tumor antibody response against normal antigens ectopically expressed by tumor cells. Although this antibody response plays an important role in helping clear a nascent or established tumor, the engagement of antigens expressed in healthy tissues can lead to complex clinical syndromes with challenging diagnosis and management. The majority of known paraneoplastic antibody syndromes have been found to affect the central and peripheral nervous system. The present review provides an update on the pathophysiology of paraneoplastic neurologic syndromes, as well as recommendations for their diagnosis and treatment.
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Affiliation(s)
- Daniel Chiu
- Department of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - John Rhee
- Department of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - L. Nicolas Gonzalez Castro
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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4
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Fukushima H, Shibuya T, Awatsu T, Kurosawa T, Haga K, Murakami T, Serizawa N, Mori A, Hojo M, Yao T, Hattori N, Nagahara A. CV2/CRMP5-antibody-related Paraneoplastic Neurologic Syndrome Associated with Gastrointestinal Stromal Tumor. Intern Med 2022; 61:1497-1501. [PMID: 34670904 PMCID: PMC9177369 DOI: 10.2169/internalmedicine.8425-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Paraneoplastic neurological syndrome (PNS) is a heterogeneous group of neurological disorders caused by immune-mediated inflammatory mechanisms. We herein report a 77-year-old man with CV2/CRMP5-antibody-related PNS associated with a gastrointestinal stromal tumor (GIST). He was admitted for forgetfulness and delusional behavior. His neurological symptoms were subacute, and a whole-body examination revealed a gastric GIST. Serology showed CV2/collapsin response mediator protein (CRMP)-5 antibodies. Partial gastrectomy was performed for the GIST, and the neurological symptoms and serum CV2/CRMP5 antibodies disappeared. No relapse has occurred since the surgery. PNS should be considered in patients with subacute neurological disorders.
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Affiliation(s)
- Hirofumi Fukushima
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Takahito Awatsu
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Taro Kurosawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Takashi Murakami
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Nobuko Serizawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Akio Mori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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5
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Sardiña González C, Martínez Vivero C, López Castro J. PARANEOPLASTIC SYNDROMES REVIEW: THE GREAT FORGOTTEN ONES. Crit Rev Oncol Hematol 2022; 174:103676. [PMID: 35378267 DOI: 10.1016/j.critrevonc.2022.103676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022] Open
Abstract
Paraneoplastic syndromes (PNS) are a group of disorders that can affect the oncologic patient, and which are not directly attributable to tumour invasion, tumour compression or metastasis. In fact, they are due to tumour secretion of functional hormones or peptides or are related to immune cross-reactivity with the host tissue. These syndromes are called paraneoplastic because the components that cause them do not derive from the organ or tissue of origin, but from the neoplasm suffered by the patient. It is estimated that 10-15% of people with cancer suffer from a PNS.(1) PNS is the second direct cause of death (27% of cases) in cancer patients, after cancer itself. Consequently, it is of remarkable importance to recognize and treat SPNs specifically.(2) In view of the above, the aim of this article is to review the state of the art in neurological, haematological, endocrine, and dermatological paraneoplastic syndromes. It is a review in which the most relevant PNS and their symptomatology are described, inquiring into their diagnosis and treatment.
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Affiliation(s)
| | | | - José López Castro
- Internal Medicine Dept. Hospital Público de Monforte de Lemos (Lugo, SPAIN)
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6
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Malhotra A, Weaver J. Approach to Neuropathic Pain. Semin Neurol 2021; 41:744-759. [PMID: 34826876 DOI: 10.1055/s-0041-1726361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuropathic pain is a common chief complaint encountered by neurologists and primary care providers. It is caused by disorders involving the somatosensory nervous system. The clinical evaluation of neuropathic pain is challenging and requires a multifaceted systematic approach with an emphasis on a thorough history and physical examination to identify characteristic signs and symptoms. Ancillary laboratory investigations, targeted imaging, and electrodiagnostic studies further help identify underlying etiologies to guide specific treatments. Management of neuropathic pain encompasses treating the underlying pathology as well as symptomatic control with nonpharmacological, pharmacological, and interventional therapies. Here, we present an approach to help evaluate patients with neuropathic pain.
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Affiliation(s)
- Ashwin Malhotra
- Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joshua Weaver
- Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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7
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Abstract
Paraneoplastic neurological syndromes are nonmetastatic complications of malignancy secondary to immune-mediated neuronal dysfunction or death. Pathogenesis may occur from cell surface binding of antineuronal antibodies leading to dysfunction of the target protein, or from antibodies binding against intracellular antigens which ultimately leads to cell death. There are several classical neurological paraneoplastic phenotypes including subacute cerebellar degeneration, limbic encephalitis, encephalomyelitis, and dorsal sensory neuropathy. The patient’s clinical presentations may be suggestive to the treating clinician as to the specific underlying paraneoplastic antibody. Specific antibodies often correlate with the specific underlying tumor type, and malignancy screening is essential in all patients with paraneoplastic neurological disease. Prompt initiation of immunotherapy is essential in the treatment of patients with paraneoplastic neurological disease, often more effective in cell surface antibodies in comparison to intracellular antibodies, as is removal of the underlying tumor.
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Affiliation(s)
- Jonathan Galli
- Department of Neurology, University of Utah, Salt Lake City, UT, 84108, USA.,2. George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - John Greenlee
- Department of Neurology, University of Utah, Salt Lake City, UT, 84108, USA
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8
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Chang K, Lwanga A, Kaur T, Helgason C. P/Q and N-type Voltage-gated Calcium Channel Binding Antibodies Associated with Paraneoplastic Chorea and Mixed Invasive Ductal and Lobular Carcinoma of the Breasts in an Elderly Patient. Cureus 2018; 10:e3097. [PMID: 30338173 PMCID: PMC6175266 DOI: 10.7759/cureus.3097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Paraneoplastic neurologic syndromes are a group of immune-mediated, cancer-associated disorders affecting the nervous system. While these syndromes are not understood fully, they are reportedly caused by an immune response against common antigens expressed by the cancer and nervous system. We describe the course of a patient who suffered paraneoplastic chorea before being diagnosed with breast cancer. A 70-year-old female presented with complaints of “shaking” movements of her head. History, physical exam findings, and preliminary workup ruled out the hereditary, metabolic, and infectious causes of chorea while brain computed tomography (CT) ruled out chorea due to a basal ganglia lesion. A paraneoplastic antibody panel identified N-type and P/Q-type voltage-gated (V-G) calcium channel binding antibodies. Subsequent age-appropriate cancer screening, which included a colonoscopy and screening mammograms, identified breast cancer. The patient had bilateral total mastectomies. Histopathology confirmed mixed invasive ductal and lobular carcinoma that was estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor 2 negative. In addition to mastectomies, the patient received adjuvant anastrozole. The appearance of choreiform movements before the diagnosis of breast cancer and the presence of paraneoplastic antibodies indicated that the chorea was most likely paraneoplastic in nature. Our patient continues to have choreiform movements despite undergoing bilateral mastectomies and receiving anastrozole, prednisone, and rituximab. We suspect the mastectomies and immune modulating therapies have not had an effect on her chorea because her P/Q and N-type V-G calcium channel binding antibodies may be intracellular. This case of paraneoplastic chorea associated with breast cancer is unusual. To the best of our knowledge, only one other case of paraneoplastic chorea associated with breast cancer has been reported in the English literature.
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Affiliation(s)
- Kevin Chang
- Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, USA
| | - Anita Lwanga
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, USA
| | - Tanjeev Kaur
- Department of Medicine/Division of Academic Internal Medicine and Geriatrics, University of Ilinois at Chicago, Chicago, USA
| | - Cathy Helgason
- Department of Neurology, University of Ilinois at Chicago, Chicago, USA
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9
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A case of paraneoplastic neuromyelitis optica associated with small cell lung carcinoma. J Neuroimmunol 2018; 316:130-132. [DOI: 10.1016/j.jneuroim.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/11/2017] [Accepted: 01/03/2018] [Indexed: 11/23/2022]
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10
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Tohid H. Anti-glutamic acid decarboxylase antibody positive neurological syndromes. ACTA ACUST UNITED AC 2017; 21:215-22. [PMID: 27356651 PMCID: PMC5107286 DOI: 10.17712/nsj.2016.3.20150596] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A rare kind of antibody, known as anti-glutamic acid decarboxylase (GAD) autoantibody, is found in some patients. The antibody works against the GAD enzyme, which is essential in the formation of gamma aminobutyric acid (GABA), an inhibitory neurotransmitter found in the brain. Patients found with this antibody present with motor and cognitive problems due to low levels or lack of GABA, because in the absence or low levels of GABA patients exhibit motor and cognitive symptoms. The anti-GAD antibody is found in some neurological syndromes, including stiff-person syndrome, paraneoplastic stiff-person syndrome, Miller Fisher syndrome (MFS), limbic encephalopathy, cerebellar ataxia, eye movement disorders, and epilepsy. Previously, excluding MFS, these conditions were calledhyperexcitability disorders. However, collectively, these syndromes should be known as "anti-GAD positive neurological syndromes." An important limitation of this study is that the literature is lacking on the subject, and why patients with the above mentioned neurological problems present with different symptoms has not been studied in detail. Therefore, it is recommended that more research is conducted on this subject to obtain a better and deeper understanding of these anti-GAD antibody induced neurological syndromes.
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Affiliation(s)
- Hassaan Tohid
- Valley View Court, Fairfield, California, United States of America. E-mail:
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11
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Malignancy in Guillain-Barré syndrome: A twelve-year single-center study. J Neurol Sci 2017; 375:275-278. [PMID: 28320147 DOI: 10.1016/j.jns.2017.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/21/2022]
Abstract
The relationship between Guillain-Barré syndrome (GBS) and malignancy is uncertain. We retrospectively analyzed data of 118 consecutive patients admitted with GBS from Birmingham, U.K. (2001-2012). We calculated relative cancer risk using different definitions and determined characteristics of malignancy-associated GBS. Malignancy was globally commoner in our GBS cohort compared to the general population (odds ratio: 2.08; CI: 1.06-3.71; p=0.036). However, this was unconfirmed if paraneoplastic criteria were applied. GBS patients with cancer were significantly more likely to be older (p=0.043), hyponatremic (p=0.037) and demonstrate more axonal loss (p<0.05). Cerebrospinal fluid (CSF) protein levels were lower in the malignancy group (p=0.002) and neurological improvement less likely (p=0.023). In-patient mortality was significantly higher in patients with malignancy (p<0.01). We conclude global cancer risk is higher in GBS than in the general population, although definition-dependent. Malignancy requires consideration in elderly, hyponatremic subjects with normal CSF protein, severe axonal loss, who fail to improve post-treatment.
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12
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Hazenfield JM, Gaskill-Shipley MF. Neoplastic and Paraneoplastic Involvement of the Spinal Cord. Semin Ultrasound CT MR 2016; 37:482-97. [DOI: 10.1053/j.sult.2016.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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Uneno Y, Yokoyama A, Nishikawa Y, Funakoshi T, Ozaki Y, Aoyama I, Baba K, Yamaguchi D, Morita S, Mori Y, Kanai M, Kinoshita H, Inoue T, Sawamoto N, Matsumoto R, Matsumoto S, Muto M. Paraneoplastic Limbic Encephalitis in a Human Epidermal Growth Factor Receptor-2-positive Gastric Cancer Patient Treated with Trastuzumab-combined Chemotherapy: A Case Report and Literature Review. Intern Med 2016; 55:2605-9. [PMID: 27629954 DOI: 10.2169/internalmedicine.55.6917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Paraneoplastic neurological syndromes (PNSs) are rare nervous system dysfunctions in cancer patients, which are primarily observed with small-cell lung cancer, gynecological cancer, and thymoma. We herein present an uncommon case of PNS in an anti-Hu antibody-positive patient with human epidermal growth factor receptor (HER)-2-positive gastric cancer (GC), who developed limbic encephalitis and a worsening cognitive function. Trastuzumab-combined chemotherapy was initiated and appeared to be partially effective for controlling the neurological symptoms and tumor volume. Chemotherapy failure eventually led to uncontrollable neurological symptoms. This is the first case demonstrating that trastuzumab-combined chemotherapy may be effective for controlling neurological symptoms of PNS in HER2-positive GC patients.
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Affiliation(s)
- Yu Uneno
- Department of Clinical Oncology, Kyoto University Hospital, Japan
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14
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Taguchi S, Nakamura T, Yamada T, Takamido H, Doyu M, Takahashi A. [Autonomic neuropathy as the first presentation of T-cell malignant lymphoma--a case report]. Rinsho Shinkeigaku 2015; 55:29-32. [PMID: 25672862 DOI: 10.5692/clinicalneurol.55.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 61-year-old man noted flu-like symptoms. Not long afterwards, he felt constipation, nausea, and blackout when standing or sitting. His blood pressure was 110/70 mmHg in the supine position. On sitting blood pressure dropped to 73/34 mmHg. Heart rate increased from 65 to 78 beats per minutes. He did not have fever, edema, or skin rash. The remainder of the general medical examination was normal. A neurological examination revealed normal higher mental, and sensori-motor functions. The blood test revealed leukocytosis 7,320/μl, LD 1,426 IU/l, IL-2R 921 U/ml, and CRP 11.5 mg/dl. A whole body CT scan and cranial MR imaging showed no significant change. Thoracic spine MR imaging revealed multiple T1 low signal small foci in part of the vertebral body suggesting bone metastasis of the tumor. The heart/mediastinum ratio of (123)I-meta-iodobenzylguanidine scintigraphy early imaging was 2.42. The nerve conduction study and electrocardiogram coefficient of variation of R-R intervals showed no abnormalities. Two months after the onset of symptoms, he was found to have glove-and-stocking-form muscle weakness and sensory impairment. The nerve conduction study performed four months after the onset revealed a decreased conduction velocity and conduction block suggesting demyelinated nerve. His neurological manifestations progressed subacutely, despite high-dose intravenous immunoglobulin therapy. Five months after the onset, a histopathological diagnosis of T-cell malignant lymphoma was made on a skin biopsy specimen from the facial rash. To summarise, the present case was a rare example of paraneoplastic autonomic neuropathy as the initial clinical feature in association with T-cell malignant lymphoma.
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Affiliation(s)
- Soutarou Taguchi
- Department of Neurology, Tokai Central Hospital; Aichi Medical University
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15
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Minami S, Okazaki T, Hamaguchi M, Shiraishi S, Yamamoto S, Ogata Y, Koba T, Futami S, Nishijima Y, Yaga M, Masuhiro K, Komuta K. Small-cell lung cancer: a case report on the manifestation of paraneoplastic motor neuron disease after effective tumor shrinkage during chemotherapy. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-014-0156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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16
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Söderström A, Revaz S, Dudler J. Cranial neuropathies in granulomatosis with polyangiitis (Wegener's): a case-based review. Clin Rheumatol 2013; 34:591-6. [PMID: 24352751 DOI: 10.1007/s10067-013-2420-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/18/2013] [Indexed: 12/19/2022]
Abstract
The purpose of this case-based review is to highlight cranial nerve involvement in granulomatosis with polyangiitis (Wegener's). In this disease, cranial nerve involvement may be less frequent than other neurological manifestations, but often goes unrecognized by physicians as a sign of the disease, and its prevalence and importance is likely underestimated. Awareness of this aspect of the disease is necessary to make the proper diagnosis rapidly, as it can be a major feature of a patient's presentation. We also briefly discuss the known pathogenic mechanisms, which could be important when selecting the best therapeutic option.
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Affiliation(s)
- Ana Söderström
- Service de Rhumatologie, Médecine Physique et Réhabilitation, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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17
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Gummadavelli A, Motelow JE, Narayanan NS. Clinical reasoning: A 64-year-old woman with progressive quadriparesis. Transverse myelitis (TM). Neurology 2013; 81:e89-94. [PMID: 24042577 DOI: 10.1212/wnl.0b013e3182a4a3f7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Abhijeet Gummadavelli
- From the Department of Neurology (A.G., J.E.M.), Yale University School of Medicine, New Haven, CT; and Department of Neurology (N.S.N.), Carver College of Medicine, University of Iowa, Iowa City
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18
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Antoine JC, Camdessanché JP. Paraneoplastic disorders of the peripheral nervous system. Presse Med 2013; 42:e235-44. [DOI: 10.1016/j.lpm.2013.01.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/16/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022] Open
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19
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Acute exacerbation of paraneoplastic neurological syndrome after massive tumor lysis of neuroendocrine carcinoma by chemoradiotherapy. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0100-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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20
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Schramm N, Rominger A, Schmidt C, Morelli JN, Schmid-Tannwald C, Meinel FG, Reiser MF, Rist C. Detection of underlying malignancy in patients with paraneoplastic neurological syndromes: comparison of 18F-FDG PET/CT and contrast-enhanced CT. Eur J Nucl Med Mol Imaging 2013; 40:1014-24. [DOI: 10.1007/s00259-013-2372-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 02/12/2013] [Indexed: 11/24/2022]
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21
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Taketa T, Ohigashi S, Suzuki K, Sudo K, Shiozaki H, Suzuki A, Blum MA, Ajani JA, Onodera H. Paraneoplastic neurological syndromes associated with gastric cancer: a case report and review of the literature. Clin J Gastroenterol 2012; 5:355-60. [PMID: 26181075 DOI: 10.1007/s12328-012-0328-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/08/2012] [Indexed: 11/27/2022]
Abstract
Paraneoplastic neurological syndromes (PNS) are associated with small-cell lung cancer, breast and gynecological cancers. We describe a gastric neoplasm presented with neurological symptoms. A 74-year-old male presented with tonic-clonic seizures. Initial investigations were normal; however, brain magnetic resonance imaging showed abnormal signal intensity in the hippocampi. A diagnosis of PNS was suspected. The patient was then diagnosed with a gastric neuroendocrine carcinoma with N-type voltage-gated calcium channel antibodies. The neurological impairments improved after the primary was resected and the patient remains free of cancer and paraneoplastic syndrome. We reviewed 10 cases of PNS associated with gastric cancer and found several characteristics: (1) older men, (2) neuroendocrine component or predominance, (3) oncological outcome for patients with PNS is better than for patients without PNS, and (4) neurological impairment is diagnosed 6 months prior to the diagnosis of gastric malignancy. In conclusion, elderly men with symptoms suggestive of PNS should be investigated for a gastric neuroendocrine malignancy.
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Affiliation(s)
- Takashi Taketa
- Department of Gastrointestinal Surgery, St Luke's International Hospital, 9-1 Akashi-cho Chuo-ku, Tokyo, 1048560, Japan
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Seiji Ohigashi
- Department of Gastrointestinal Surgery, St Luke's International Hospital, 9-1 Akashi-cho Chuo-ku, Tokyo, 1048560, Japan
| | - Koyu Suzuki
- Department of Pathology, St Luke's International Hospital, Tokyo, Japan
| | - Kazuki Sudo
- Department of Gastrointestinal Surgery, St Luke's International Hospital, 9-1 Akashi-cho Chuo-ku, Tokyo, 1048560, Japan
| | - Hironori Shiozaki
- Department of Gastrointestinal Surgery, St Luke's International Hospital, 9-1 Akashi-cho Chuo-ku, Tokyo, 1048560, Japan
| | - Akihiro Suzuki
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Mariela A Blum
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Hisashi Onodera
- Department of Gastrointestinal Surgery, St Luke's International Hospital, 9-1 Akashi-cho Chuo-ku, Tokyo, 1048560, Japan.
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22
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Aregawi DG, Sherman JH, Schiff D. Neurological complications of solid tumors. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:683-710. [PMID: 22230528 DOI: 10.1016/b978-0-444-53502-3.00018-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Dawit G Aregawi
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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Abstract
Although direct neoplastic involvement of muscle tis-sue is surprisingly rare, considering the large amount of body mass that is represented by muscle tissue, the most important and unresolved muscle effect is muscle cachexia.Other associations, such as inflammatory, paraneo-plastic, toxic, and several extremely rare associations,have been described. Drug-induced toxicity and radiation recall syndrome need to be taken into consideration when muscle symptoms appear in patients with cancer.
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Chad DA, Stone JH, Gupta R. Case records of the Massachusetts General Hospital. Case 14-2011. A woman with asymmetric sensory loss and paresthesias. N Engl J Med 2011; 364:1856-65. [PMID: 21561352 DOI: 10.1056/nejmcpc1012550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David A Chad
- Department of Neurology, Massachusetts General Hospital, Boston, USA
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25
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Abstract
EDUCATIONAL OBJECTIVES To discuss a case of progressive four-limb paresthesias and gait difficulty in a female who had previously undergone gastric bypass surgery. KEY QUESTIONS 1) What is the differential diagnosis of progressive four-limb paresthesias and gait difficulty? 2) How would one approach diagnostic testing for such a patient? 3) What are the complications of gastric bypass surgery? 4) What is the treatment for this patient?
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26
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Paraneoplastic neurological syndrome in a patient with gastric cancer. Gastric Cancer 2010; 13:204-8. [PMID: 20820991 DOI: 10.1007/s10120-010-0563-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 06/07/2010] [Indexed: 02/07/2023]
Abstract
Paraneoplastic neurological syndromes (PNSs) are a heterogeneous group of neurological disorders caused by immune-mediated mechanisms. The incidence of PNS is much less than 1% for solid tumors, except for small-cell lung cancer and thymoma. We report a rare case of gastric cancer that presented with primary clinical findings of PNS. The patient was a 63-year-old woman who was admitted for worsening neuropathy. Laboratory and neurological tests excluded a nutritional deficit, diabetes mellitus, and connective tissue disease as causes of her neuropathy. Computed tomography (CT) of the abdomen, positron emission tomography (PET)-CT, and endoscopy of the stomach revealed gastric cancer with lymph node swelling. Distal gastrectomy was performed and pathological and immunohistochemical examinations indicated endocrine cell carcinoma. The gastrectomy stopped the exacerbation of her symptoms and recurrence was not observed, but the neurological disorders were irreversible. This case suggests that early diagnosis of the primary tumor is required to improve the outcome in patients with PNS.
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Moscato EH, Jain A, Peng X, Hughes EG, Dalmau J, Balice-Gordon RJ. Mechanisms underlying autoimmune synaptic encephalitis leading to disorders of memory, behavior and cognition: insights from molecular, cellular and synaptic studies. Eur J Neurosci 2010; 32:298-309. [PMID: 20646055 DOI: 10.1111/j.1460-9568.2010.07349.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recently, several novel, potentially lethal and treatment-responsive syndromes that affect hippocampal and cortical function have been shown to be associated with auto-antibodies against synaptic antigens, notably glutamate or GABA-B receptors. Patients with these auto-antibodies, sometimes associated with teratomas and other neoplasms, present with psychiatric symptoms, seizures, memory deficits and decreased levels of consciousness. These symptoms often improve dramatically after immunotherapy or tumor resection. Here we review studies of the cellular and synaptic effects of these antibodies in hippocampal neurons in vitro and preliminary work in rodent models. Our work suggests that patient antibodies lead to rapid and reversible removal of neurotransmitter receptors from synaptic sites, leading to changes in synaptic and circuit function that in turn are likely to lead to behavioral deficits. We also discuss several of the many questions raised by these and related disorders. Determining the mechanisms underlying these novel anti-neurotransmitter receptor encephalopathies will provide insights into the cellular and synaptic bases of the memory and cognitive deficits that are hallmarks of these disorders, and potentially suggest avenues for therapeutic intervention.
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Affiliation(s)
- Emilia H Moscato
- Department of Neuroscience, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6074, USA
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28
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Tanaka M, Tanaka K. Pathogenesis and treatment of paraneoplastic neurologic syndrome. Expert Rev Neurother 2010; 2:901-9. [PMID: 19810923 DOI: 10.1586/14737175.2.6.901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Paraneoplastic neurologic syndrome, a rare complication of carcinoma, includes various neurologic disorders, such as encephalomyelitis, paraneoplastic cerebellar degeneration, subacute sensory neuronopathy, retinal paraneoplastic syndrome, opsoclonus-myoclonus syndrome and stiff-person syndrome. Several antibodies to malignant tumor cells and neurons are detected in sera and cerebrospinal fluids of patients with this syndrome, however, there is no direct evidence of antiYo or antiHu antibodies' causative roles in neuronal loss. Recent studies showed cytotoxic T-cell activities against peptides of an antigen protein recognized by antibodies in the peripheral blood of patients with paraneoplastic cerebellar degeneration and antiYo antibodies, as well as in patients with antiHu syndrome. Treatment of paraneoplastic neurologic syndrome with plasmapheresis, immunosuppresive drugs, or intravenous immunoglobulin therapy has been attempted. Here, we discuss previous reports and theoretical treatments based on recent etiological hypothesis of paraneoplastic cerebellar degeneration.
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Affiliation(s)
- Masami Tanaka
- Department of Neurology and Clinical Research Center, Nishi-Niigata Central Hospital, Niigata, Japan.
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29
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Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol 2010; 4:175-81. [PMID: 18615140 DOI: 10.2174/157015906778019536] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 01/26/2023] Open
Abstract
Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain.
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Affiliation(s)
- P Marchettini
- Pain Medicine Center, Scientific Institute San Raffaele, Via Stamira D'Ancona 20, 20127 Milano, Italy.
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30
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31
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Abstract
The means whereby vision can be lost from a disease located distant from the eye include autoimmunity, with sensitization resulting from extraocular stimuli, a process illustrated here by the immunologic confusion caused by cancers. The uncontrolled proliferation of malignancies commonly involves the expression of components of the central nervous system, but a damaging loss of tolerance is rare. When autoimmunity does develop, organ-specific antigens are more often involved than the more generalized and widely disseminated common neuronal components. A focus upon a single antigen is typical of the immune-mediated paraneoplasia, a collection of syndromes identified by unusual antibody reactions. This review provides an outline of the immunologic trail that led to the recognition of autoimmunity in paraneoplastic ocular degenerations, how specific antibody reactions aid in diagnosis, and the possibility of including antibodies in modes for sight-saving intervention. 'Those who do not know history are destined to repeat it'.
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Affiliation(s)
- Charles E Thirkill
- CAR Reference Laboratory, Research One, U.C. Davis Medical Center, Sacramento, CA 95817, USA.
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32
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Lim A, Scriven A, Knezevic W, Texler M. A predominantly left upper limb sensory neuronopathy as a manifestation of a metastatic neuroendocrine malignancy. J Clin Neurosci 2009; 16:838-9. [DOI: 10.1016/j.jocn.2008.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/08/2008] [Accepted: 08/21/2008] [Indexed: 11/29/2022]
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Steroid-responsive paraneoplastic demyelinating neuropathy and myelopathy associated with breast carcinoma. J Clin Neuromuscul Dis 2009; 10:65-9. [PMID: 19169093 DOI: 10.1097/cnd.0b013e31818e952b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Paraneoplastic myeloneuropathy has rarely been reported with breast cancer. We report the case of a 59-year-old woman who presented with a peripheral neuropathy and cranial involvement and later developed a myelopathy. The neuropathy was found to be electrophysiologically and histologically demyelinating in nature. Magnetic resonance imaging studies failed to identify any structural brain or spinal cord abnormalities. The patient was diagnosed with breast carcinoma 4 months after initial presentation and underwent resective surgery, radiotherapy, and hormonotherapy. Paraneoplastic antibodies (anti-Hu, anti-Yo, anti-Ri, anti-CV2, anti-Ma, and anti-amphiphysin) were all negative. Her condition did not progress further after cancer treatment. Partial neurologic improvement occurred with oral steroid therapy, with subsequent deterioration on treatment withdrawal.
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35
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Abstract
Major advances in the management of paraneoplastic neurologic disorders (PND) include the detection of new antineuronal antibodies, the improved characterisation of known syndromes, the discovery of new syndromes, and the use of CT and PET to reveal the associated tumours at an early stage. In addition, the definition of useful clinical criteria has facilitated the early recognition and treatment of these disorders. In this article, we review some classic concepts about PND and recent clinical and immunological developments, focusing on paraneoplastic cerebellar degeneration, opsoclonus-myoclonus, and encephalitides affecting the limbic system.
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36
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37
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Storstein A, Vedeler CA. Paraneoplastic neurological syndromes and onconeural antibodies: clinical and immunological aspects. Adv Clin Chem 2007; 44:143-85. [PMID: 17682342 DOI: 10.1016/s0065-2423(07)44005-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Paraneoplastic neurological syndromes (PNS) are infrequent disorders that are associated with cancer. The syndromes are highly heterogeneous and often affect several areas of the nervous system. Among the most well-known syndromes are paraneoplastic encephalomyelitis, cerebellar degeneration, sensory neuronopathy, and Lambert-Eaton myastenic syndrome. There are various associated tumors, in particular small cell lung cancer, cancer of the breast and ovary, and thymoma. The onset of neurological symptoms often precedes the cancer diagnosis, and the recognition of a paraneoplastic syndrome should lead to immediate search for cancer. The etiology of the paraneoplastic syndromes is believed to be autoimmune. Antibodies to onconeural antigens, expressed in the tumor of the affected individual and in normal neurons, are found in many of the patients. These antibodies are useful markers for paraneoplastic etiology. The pathogenesis of the PNS is uncertain, but cellular immune responses are thought to be the main effector mechanism. The cornerstone of therapy is the identification and treatment of the underlying malignancy. In some of the disorders, immunosuppressive therapy is of additional benefit. The prognosis of the different PNS varies depending on the level of affection and the degree of neuronal death.
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Affiliation(s)
- Anette Storstein
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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38
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Abstract
Involvement of the peripheral nervous system (PNS) is common in patients with cancer and any part, including motor neurons, sensory ganglia, nerve roots, plexuses, cranial and peripheral nerves, and neuromuscular junctions, can be affected. Different mechanisms can initiate damage associated with cancer-related PNS disorders. These include tumour infiltration, toxicity of treatments, metabolic and nutritional perturbations, cachexia, virus infections, and paraneoplastic neurological syndromes. The type of cancer, lymphoma, or solid tumour is a further determinant of a PNS disorder. In this Review we discuss the different causes and mechanisms of disorders of the PNS in patients with cancer and we will focus on their assessment and diagnosis.
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39
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Abstract
BACKGROUND Neuromuscular junction disorders are usually categorized as either presynaptic or postsynaptic. The most frequently encountered disorder of the postsynaptic neuromuscular junction is acquired myasthenia gravis. Lambert-Eaton myasthenic syndrome is a well-known prototype of the presynaptic autoimmune disorders of neuromuscular transmission. These major disorders of neuromuscular transmission are relatively common and distinctly recognized, but co-occurrence of these disorders (overlap myasthenic syndrome) is rare and has so far attracted little attention. REVIEW SUMMARY This report describes a patient with acquired myasthenia gravis and immunologic coexistence of Lambert-Eaton myasthenic syndrome (overlap myasthenic syndrome) in association with abdominal/uterine leiomyosarcoma. The patient presented with acute respiratory failure, making identification and management of her illness challenging. A general overview of the complexities associated with overlap between myasthenia gravis and Lambert-Eaton myasthenic syndrome is provided and this patient's complicated clinical course and response to therapy are discussed. CONCLUSION To our knowledge, this is the first report of overlap myasthenic syndrome in conjunction with abdominal leiomyosarcoma. The immunologic coexistence of acquired myasthenia gravis and Lambert-Eaton myasthenic syndrome in a patient with a malignant smooth-muscle tumor is intriguing and suggests that a common paraneoplastic process targeting 2 different onconeural antigens was the underlying pathogenic mechanism in this patient.
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Affiliation(s)
- Fereydoon Roohi
- Department of Neurology and the Division of Pulmonary Medicine, Long Island College Hospital, Brooklyn, New York 11201, USA.
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40
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Wanschitz J, Dichtl W, Budka H, Löscher WN, Boesch S. Acute motor and sensory axonal neuropathy in Burkitt-like lymphoma. Muscle Nerve 2006; 34:494-8. [PMID: 16671108 DOI: 10.1002/mus.20569] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Immune-mediated neuropathies associated with non-Hodgkin's lymphoma are rare and can be difficult to delineate from neuropathies of other etiologies. We report the clinical and pathological findings of a 36-year-old patient with fulminant quadriplegic neuropathy, left facial nerve palsy, and Burkitt-like lymphoma. Features of the neuropathy, which occurred during induction chemotherapy with a total cumulative dose of 4 mg vincristine, suggested axonal Guillain-Barré syndrome. There was no evidence of direct malignant infiltration of the peripheral nervous system. We hypothesize that immune mechanisms triggered by the lymphoma initiated damage to the peripheral nervous system and enhanced its vulnerability to the toxic effects of vincristine.
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Affiliation(s)
- Julia Wanschitz
- Clinical Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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41
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Bataller L, Dalmau J. PARANEOPLASTIC DISORDERS OF THE NERVOUS SYSTEM. Continuum (Minneap Minn) 2005. [DOI: 10.1212/01.con.0000293680.24426.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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42
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Cartalat-Carel S, Camdessanché JP, Antoine JC, Honnorat J. Syndromes neurologiques paranéoplasiques. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.emcn.2004.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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44
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Petzold GC, Marcucci M, Butler MH, van Landeghem FKH, Einhäupl KM, Solimena M, Valdueza JM, De Camilli P. Rhabdomyolysis and paraneoplastic stiff-man syndrome with amphiphysin autoimmunity. Ann Neurol 2004; 55:286-90. [PMID: 14755734 DOI: 10.1002/ana.10841] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stiff-Man syndrome (SMS) is a rare disease of the central nervous system characterized by chronic muscle rigidity and autoimmunity directed against synaptic antigens. In a subset of patients, generally positive for antiamphiphysin autoantibodies, SMS has an autoimmune paraneoplastic origin. Amphiphysin isoforms are expressed at high levels in brain and skeletal muscle and often are overexpressed in breast cancer. We report here the occurrence of rhabdomyolysis in a patient with SMS, breast cancer, and antibodies that recognize both brain and muscle amphiphysin isoforms. Immunotherapy induced a remission of both rhabdomyolysis and SMS symptoms. Autoimmune rhabdomyolysis may represent a paraneoplastic complication of cancer patients with amphiphysin autoimmunity.
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Affiliation(s)
- Gabor C Petzold
- Department of Neurology, Charité Hospital, Humboldt University, Berlin, Germany
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45
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Abstract
Paraneoplastic disorders can affect any part of the central or peripheral nervous system. Although relatively uncommon, these disorders are a significant cause of severe neurologic disability among cancer patients. Many paraneoplastic disorders are believed to be caused by an autoimmune response directed against shared neural tumor antigens. This article summarizes the clinical features, possible autoimmune pathophysiology, and management issues for patients with paraneoplastic disorders.
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Affiliation(s)
- Edward J Dropcho
- Department of Neurology, Indiana University Medical Center, CL 291, Indianapolis, IN 46202, USA.
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46
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Affiliation(s)
- Robert B Darnell
- Howard Hughes Medical Institute, Rockefeller University, New York, USA
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47
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Grisold W, Oberndorfer S, Vass A. Neuromuscular symptoms in cancer patients. Expert Rev Neurother 2003; 3:501-10. [PMID: 19810934 DOI: 10.1586/14737175.3.4.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The neuromuscular system is often affected in patients with cancer. This can be due to a direct effect of cancer, neurotoxic treatment, radiation therapy or paraneoplastic phenomena. This review focuses on the sites of involvement, such as cranial nerves, nerve roots, and plexus, mono- and polyneuropathies disorders at neuromuscular transmission, and muscle disease. At each site of the peripheral nervous system, the most common types of involvement and therapeutic issues are discussed. Knowledge of neuromuscular symptoms is important for medical oncologists, neurologists and neuro-oncologist alike, as precise diagnosis may have therapeutic consequences for the patients. Immunologic therapies, or in some cases anticancer treatment may decrease the individual's burden of disease in paraneoplastic syndromes. Conventional cancer therapies, such as chemotherapy and radiation therapy, also have neurotoxic side effects which need to be outweighed against their therapeutic effect. Several other less well-defined complications such as infection, hemorrhage or metabolic disorders have to be considered as a differential diagnosis. Complications of surgical and other interventions will not be discussed in this context.
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Affiliation(s)
- Wolfgang Grisold
- Ludwig Boltzmann Institute for Neuro-oncology, Neurologic Department, Kaiser Franz Josef Hospital, Vienna, Austria.
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48
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Abstract
Cancer can affect the nervous system through many metastatic and nonmetastatic mechanisms, including side effects of cancer treatment, infections, coagulopathy, and metabolic or nutritional deficits. Paraneoplastic neurologic disorders (PND) are an extensive group of syndromes that cannot be explained by any of these complications and may affect any part of the nervous system. PND often develop before the presence of a cancer is known and their recognition may lead to the tumor diagnosis.
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Affiliation(s)
- Luis Bataller
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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