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Cincotta MC, Walker RH. Recent advances in non-Huntington's disease choreas. Parkinsonism Relat Disord 2024; 122:106045. [PMID: 38378310 DOI: 10.1016/j.parkreldis.2024.106045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chorea is primarily due to an imbalance of basal ganglia output pathways, often due to dysfunction or degeneration of the caudate nucleus and putamen, and can be due to many causes. METHODS We reviewed the recent literature to identify newly-recognized causes of chorea, including auto-immune, metabolic, and genetic. We also focused upon developments in mechanisms relating to underlying pathophysiology of certain genetic choreas and advances in therapeutics. RESULTS Novel autoantibodies continue to be identified as causes of chorea. Both COVID-19 infection and vaccination are reported to result rarely in chorea, although in some cases causality is not clearly established. Advances in genetic testing continue to find more causes of chorea, and to expand the phenotype of known genetic disorders. Deep brain stimulation can be successful in certain circumstances. CONCLUSION Our understanding of mechanisms underlying this movement disorder continues to advance, however much remains to be elucidated.
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Affiliation(s)
- Molly C Cincotta
- Department of Neurology, Temple University, Philadelphia, PA, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Neurology, Mount Sinai School of Medicine, New York City, NY, USA.
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2
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Wang S, Hou H, Tang Y, Zhang S, Wang G, Guo Z, Zhu L, Wu J. An overview on CV2/CRMP5 antibody-associated paraneoplastic neurological syndromes. Neural Regen Res 2023; 18:2357-2364. [PMID: 37282453 PMCID: PMC10360094 DOI: 10.4103/1673-5374.371400] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Paraneoplastic neurological syndrome refers to certain malignant tumors that have affected the distant nervous system and caused corresponding dysfunction in the absence of tumor metastasis. Patients with this syndrome produce multiple antibodies, each targeting a different antigen and causing different symptoms and signs. The CV2/collapsin response mediator protein 5 (CRMP5) antibody is a major antibody of this type. It damages the nervous system, which often manifests as limbic encephalitis, chorea, ocular manifestation, cerebellar ataxia, myelopathy, and peripheral neuropathy. Detecting CV2/CRMP5 antibody is crucial for the clinical diagnosis of paraneoplastic neurological syndrome, and anti-tumor and immunological therapies can help to alleviate symptoms and improve prognosis. However, because of the low incidence of this disease, few reports and no reviews have been published about it so far. This article intends to review the research on CV2/CRMP5 antibody-associated paraneoplastic neurological syndrome and summarize its clinical features to help clinicians comprehensively understand the disease. Additionally, this review discusses the current challenges that this disease poses, and the application prospects of new detection and diagnostic techniques in the field of paraneoplastic neurological syndrome, including CV2/CRMP5-associated paraneoplastic neurological syndrome, in recent years.
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Affiliation(s)
- Sai Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yao Tang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shuang Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Gege Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ziyan Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lina Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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3
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Bhattacharya K, Nigam K, Choudhari AKJ, Shetty NS, Gala K, Chandra D, Kulkarni S. Imaging of central nervous system emergencies in oncology. Emerg Radiol 2023; 30:499-512. [PMID: 37160605 DOI: 10.1007/s10140-023-02139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
Central nervous system (CNS) may be predisposed to devastating complications in cancer patients which may add to morbidity and mortality in this group. Majority of the complications are vascular in nature due to the altered coagulation profile and pro-inflammatory state in these patients. However, there are a host of other conditions which may affect the clinical course of these patients including metabolic and toxic encephalopathies, infections, and paraneoplastic syndromes. Moreover, multimodality management of these patients, which is often used in majority of the cancers, exposes them to treatment related complications. This pictorial review aims to enlighten the reader regarding the various complications affecting the CNS as seen at our tertiary cancer care institute. We aim to highlight the emergent nature of these complications and the need to identify them quickly and accurately on imaging which helps to institute early appropriate management and prevents further morbidity and mortality.
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Affiliation(s)
- Kajari Bhattacharya
- Department of Radiology, Tata Memorial Centre, Mumbai, India.
- Homi Bhabha National Institute, Mumbai, India.
| | - Kunal Nigam
- Department of Radiology, Tata Memorial Centre, Mumbai, India
| | - Amit Kumar J Choudhari
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Nitin Sudhakar Shetty
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kunal Gala
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Daksh Chandra
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Suyash Kulkarni
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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4
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Huang P, Xu M. Four kinds of antibody positive paraneoplastic limbic encephalitis: A rare case report. World J Clin Cases 2023; 11:1586-1592. [PMID: 36926412 PMCID: PMC10012000 DOI: 10.12998/wjcc.v11.i7.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/14/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND It is not uncommon to develop autoimmune encephalitis and paraneoplastic neurological syndromes (PNS). 4 kinds of antibody-positive autoimmune paraneoplastic limbic encephalitis (PLE) have not been reported.
CASE SUMMARY PNS are distant effects of cancer on the nervous system, rather than syndromes in which cancer directly invades and metastasizes to the nerves and/or muscle tissues. If the limbic lobe system of the brain is involved, this will result in PLE. The detection of patients with PNS is challenging since tumors that cause paraneoplastic neurologic disorders are often asymptomatic, obscure, and thus easily misdiagnosed or missed. Currently, single- or double-antibody-positive paraneoplastic marginal encephalitis has been reported. However, no cases of three or more-antibody-positive cases have been reported. Here, we report a case of PLE that is anti-collapsing response-mediator protein-5, anti-neuronal nuclear antibody-type 1, anti-aminobutyric acid B receptor, and anti-glutamate deglutase positive, and address relevant literature to improve our understanding of the disease.
CONCLUSION This article reports on the management of a case of PLE with four positive antibodies, a review of the literature, in order to raise awareness among clinicians.
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Affiliation(s)
- Pan Huang
- Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan Province, China
| | - Min Xu
- Department of Neurology, The Second People’s Hospital of Deyang City, Deyang 618000, Sichuan Province, China
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5
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Verma R, Chakraborty R. An Intractable Case of Anti-N-methyl-D-aspartate Receptor Encephalitis with Prolonged Hyperammonemia. J Neurosci Rural Pract 2022; 13:354-356. [PMID: 35694073 PMCID: PMC9187407 DOI: 10.1055/s-0042-1744124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajarshi Chakraborty
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
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6
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Holroyd KB, Rubin DB, Vaitkevicius H. Neurologic Complications in Patients with Cancer. Semin Neurol 2021; 41:588-605. [PMID: 34619783 DOI: 10.1055/s-0041-1733788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurologic symptoms are commonly seen in patients with cancer and can be among the most challenging to diagnose and manage. It is often difficult to determine if new neurologic symptoms are secondary to direct effects of a malignant lesion, systemic complications of disease, paraneoplastic disorders, or side effects of cancer treatment itself. However, early diagnosis and treatment of each of these conditions can improve patients' quality of life and long-term functional outcomes. In this review, we describe a systematic approach to the diagnosis of new neurologic symptoms in patients with known malignancy. We have categorized the neurologic complications of cancer through a mechanistic approach, with an emphasis on ascertaining underlying pathophysiology to guide treatment choice. This review focuses on the acute neurologic complications of cancer that require hospital admission.
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Affiliation(s)
| | - Daniel B Rubin
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts
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7
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Sun X, Liu J, Yang M, Huang L. Axillary mass in a woman with progressive exertional limbs numbness and fatigue: a case report. Gland Surg 2021; 10:1154-1157. [PMID: 33842259 DOI: 10.21037/gs-20-780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Occult breast cancer (OBC) is a very rare type of breast cancer which accounts for only 0.2% to 0.9% of all breast cancer defined as histologically proven breast cancer found from outside the breast especially axillary with the absence of a primary tumor in the breast. With the development of high-resolution ultrasound, mammography, especially breast-enhanced MRI, the incidence of OBC has decreased in recent years. A standard approach for OBC is to perform a modified radical mastectomy (MRM) at the time of axillary lymph node dissection (ALND). The five-year survival rates after treatment of an occult primary breast cancer with axillary metastases range from 59% to 93%, averaging about 75%. Paraneoplastic neurological syndromes (PNS) are a very rare heterogeneous group of disease caused by mechanisms of the remote effects of malignant tumors other than tumor metastases, infections or side effects of tumor treatment. Malignant tumors with PNS account for only less than 0.01% of all tumors. The treatment of PNS include removal of the tumors and suppression of the immune response. The prognosis of PNS depends on the degree of neuronal damage during the treatment of the disease. PNS is a rare neurological complication in patients with breast cancer and particularly rare in the patients with OBC. Here, we report a rare case of a 62-year-old woman diagnosed as OBC who presented with PNS as the first symptom.
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Affiliation(s)
- Xiaoliang Sun
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jun Liu
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Meng Yang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Linping Huang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
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8
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Altintas A, Dargvainiene J, Schneider-Gold C, Asgari N, Ayzenberg I, Ciplea AI, Junker R, Leypoldt F, Wandinger KP, Hellwig K. Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG). Ther Adv Neurol Disord 2020; 13:1756286420949808. [PMID: 32922516 PMCID: PMC7450460 DOI: 10.1177/1756286420949808] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD), autoimmune encephalitis (AE), myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) are antibody-mediated neurological diseases. They have mostly female predominance, affecting many women during childbearing age. Interactions between the underlying disease (or necessary treatment) and pregnancy can occur in every of these illnesses. Herein, we present the characteristics of NMOSD, AE, MG and LEMS in general, and review published data regarding the influence of the different diseases on fertility, pregnancy, puerperium, treatment strategy during pregnancy and post-partum period, and menopause but also male factors. We summarise key elements that should be borne in mind when confronted with such cases.
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Affiliation(s)
- Ayse Altintas
- Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey
| | - Justina Dargvainiene
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | | | - Nasrin Asgari
- Department of Neurology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Germany
| | - Andrea I Ciplea
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Frank Leypoldt
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Klaus-Peter Wandinger
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Gudrunstrasse 56, Bochum, 44791, Germany
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9
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Lebeer M, Montagna M, Coito S, Reynders T, Raskin J. A rare case of Opsoclonus-Myoclonus associated with SCLC. Acta Neurol Belg 2020; 120:1017-1019. [PMID: 32557266 DOI: 10.1007/s13760-020-01402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M Lebeer
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium.
| | - M Montagna
- Neurology and Stroke Unit Department, AZ Rivierenland, Rumst, Belgium
| | - S Coito
- Laboratoire Luxembourgeois d'analyses médicales, LLAM S.A., Luxembourg, Luxembourg
| | - T Reynders
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - J Raskin
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
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10
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A Case of Paraneoplastic Myoclonus Attributed to Non-Small Cell Lung Cancer. Tremor Other Hyperkinet Mov (N Y) 2020; 10:7. [PMID: 32775021 PMCID: PMC7394212 DOI: 10.5334/tohm.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: It is well known that myoclonus can be a paraneoplastic manifestation of underlying malignancy. Case Report: A 78-year-old male diagnosed with papillary variant non-small cell lung cancer (NSCLC) presented with tremulousness that rapidly evolved into severe, diffuse myoclonus with prominent palatal involvement requiring intubation. The generalized myoclonus resolved with on levetiracetam, chemotherapy and immune modulation. While low titer positive P/Q type calcium channel autoantibodies were detected, it’s etiologic relevance is unclear. Discussion: This case highlights a rare neurologic paraneoplastic presentation of papillary NSCLC. It also illustrates the importance of monitoring airway safety when myoclonus is generalized. Highlights: A new, rare paraneoplastic presentation of papillary variant non-small cell lung adenocarcinoma is described. The patient presented with severe diffuse myoclonus with prominent palatal involvement without encephalitis that responded to a combination of chemotherapy, immune modulation, and levetiracetam. No clear causal antibody was found.
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11
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Li L. Secondary Parkinson disease caused by breast cancer during pregnancy: A case report. World J Clin Cases 2019; 7:4052-4056. [PMID: 31832408 PMCID: PMC6906578 DOI: 10.12998/wjcc.v7.i23.4052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paraneoplastic neurological syndrome manifesting as secondary Parkinson disease caused by breast cancer is extremely rare.
CASE SUMMARY We report a 39-year-old primipara of 31 gestational weeks, who presented with worsening tremors, facial stiffness and speech disfluencies, and decreased limb strength. Thorough physical examinations and auxiliary tests suggested secondary Parkinson’s disease, but the pathogenesis was unknown. During the cesarean section at the 31 weeks plus 6 d, an exploration and liver biopsy revealed a metastatic, poorly differentiated adenocarcinoma. The positron emission tomography and immunohistochemical analysis confirmed a breast ductal carcinoma of stage IV. To our knowledge, only two reports have documented the association between the breast cancer and the Parkinson disease, and neither occurred in pregnant women.
CONCLUSION Our case alerts the secondary Parkinson disease as the possible presentation of breast cancer, the most common malignancy during pregnancy.
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Affiliation(s)
- Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
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12
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 760] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Zhu L, Deng X, Lai Z, Xie N, Tan W. Paraneoplastic limbic encephalitis cured with nephron-sparing surgery in a patient with clear cell renal cell carcinoma: a case report. J Int Med Res 2019; 47:5318-5322. [PMID: 31510835 PMCID: PMC6833412 DOI: 10.1177/0300060519863524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paraneoplastic limbic encephalitis (PLE) in association with clear cell renal cell carcinoma has never been reported in China. We herein describe a 54-year-old man with a 1-week history of headache and a 3-day history of psychiatric symptoms. Slight nuchal rigidity was found by physical examination. Imaging studies of the head were normal. Blood and cerebrospinal fluid antibody testing were both positive for N-methyl-D-aspartic acid antibodies. Subsequent contrast-enhanced computed tomography revealed a 5.2- × 4.2-cm left kidney mass with intense enhancement. Emergent laparoscopic nephron-sparing surgery was successfully performed. Immunohistochemistry revealed clear cell renal cell carcinoma. The patient’s status improved after the surgery, and he was discharged after 1 month of hospitalization. At the 6-month follow-up, magnetic resonance imaging showed no recurrence, and the patient was living independently. This case indicates the potential effect of nephron-sparing surgery in the treatment of PLE. Tumor screening should be performed early in patients with suspected PLE. Early surgical resection of the primary tumor can improve patients’ prognosis.
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Affiliation(s)
- Lunfeng Zhu
- Deptartment of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Xiaolin Deng
- Deptartment of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China.,Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China
| | - Zhaohui Lai
- Deptartment of Neurology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Ning Xie
- Deptartment of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China
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14
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Kondo T, Igari R, Sato H, Iseki C, Ishizawa K, Suzuki K. [Recurrent ataxia and respiratory failure with probable paraneoplastic syndrome responsive to plasma exchange therapy]. Rinsho Shinkeigaku 2019; 59:339-344. [PMID: 31142706 DOI: 10.5692/clinicalneurol.cn-001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 80-year-old male with prostatic adenocarcinoma who was treated with orchiectomy presented dysarthria and difficulty in walking. His symptoms subacutely progressed. Seven days later, he was non-ambulatory and was admitted to our hospital. He had poor vision and cerebellar ataxia of the lower extremities; however, his muscle strength, tendon reflexes, and sensory functions were preserved. Paraneoplastic retinopathy was diagnosed based on electroretinographic and visual field defect. Further, brain and spinal MRI, cerebral spinal fluid, and nerve conduction assessments were normal. These symptoms were followed by consciousness disturbance and respiratory failure; consequently, he required non-invasive positive pressure ventilation (NPPV) and tube feeding. Steroid pulse therapy and plasma exchange (PE) were performed. In response to the therapy, all these symptoms were relieved, and NPPV and tube feeding were withdrawn. However, the same symptoms occurred additional three times throughout the course of approximately 1 year. Each time, PE was the most effective treatment. Although paraneoplastic neurological syndrome associated with prostatic cancer is rare, immunotherapy could be a therapeutic choice to relive symptoms.
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Affiliation(s)
- Toshiyuki Kondo
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine
| | - Ryosuke Igari
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine
| | - Hiroyasu Sato
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine
| | - Chifumi Iseki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine
| | - Kenichi Ishizawa
- Department of Third Internal Medicine Division of Hematology and Cell Therapy, Yamagata University Faculty of Medicine
| | - Kyoko Suzuki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine.,Present Address: Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine
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15
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Abstract
Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.
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Affiliation(s)
- Kelly Graham Gwathmey
- Virginia Commonwealth University, Department of Neurology, 1101 E. Marshall Street, PO Box 980599, Richmond, VA 23298, USA
| | - Kathleen T Pearson
- Virginia Commonwealth University, Department of Neurology, 1101 E. Marshall Street, PO Box 980599, Richmond, VA 23298, USA
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16
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Paraneoplastic neurological syndromes: a single institution 10-year case series. J Neurooncol 2019; 141:431-439. [PMID: 30607708 DOI: 10.1007/s11060-018-03053-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given its rare incidence, there are few epidemiological case series on paraneoplastic neurologic syndromes (PNS). METHODS We present a 10-year series compiled in the Section of Neuro-Oncology, Yale Cancer Center between 2002 and 2012. RESULTS Twenty-five cases met the PNS Euro-network criteria for definitive PNS. Most (64%; 16/25) had no known neoplasm. Cerebrospinal fluid pleocytosis declined logarithmically over time. Neuroimaging abnormalities were seen in 88% of cases (15/17), but with delayed onset. Therapeutic benefit correlated strongly to pre-treatment modified Rankin Scale (mRS) (p < 0.01), but not with time elapsed between syndrome onset to treatment (p = 0.8), first immunotherapy modality (corticosteroids: n = 10; IVIG: n = 10; PLEX: n = 3; p = 0.37), or number of immunotherapy modalities provided (p = 0.17). PNS-related mortality was high (24%; 6/25). Nonetheless, 16% (3/18; 7 living patients censored) survived over 6 times the anticipated median expected by tumor type and stage. CONCLUSIONS PNS are rare, at an estimated incidence of 3.1 cases per million-person-years. Detection of CSF pleocytosis and MRI abnormalities depend on time of analysis. While PNS-related mortality was high, immunotherapy benefit correlated strongly with pre-treatment mRS and long-term survival is possible.
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17
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Voeller J, Ikonomidou C, Brucker J, Diamond C, Frierdich S, Patel N. Autoimmune Ataxia During Maintenance Therapy for Acute Lymphoblastic Leukemia. Child Neurol Open 2018; 5:2329048X18819235. [PMID: 30574519 PMCID: PMC6295710 DOI: 10.1177/2329048x18819235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/16/2018] [Accepted: 11/24/2018] [Indexed: 01/12/2023] Open
Abstract
Neurologic dysfunction during acute lymphoblastic leukemia treatment is commonly associated with chemotherapy. Nonchemotherapy contributions should be considered for persistent atypical symptoms. We describe a boy with acute lymphoblastic leukemia who developed recurrent fevers, diarrhea, progressive ataxia, and neuropsychiatric impairment during maintenance chemotherapy. He was found to have cytomegalovirus in his serum and colon, but not in his cerebrospinal fluid. Instead, his cerebrospinal fluid revealed oligoclonal bands not present in the serum, suggesting an autoimmune process. Prompt treatment with ganciclovir and immunotherapy resulted in marked clinical improvement. Early recognition and treatment of an autoimmune encephalitis is paramount for optimal clinical outcome.
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Affiliation(s)
- Julie Voeller
- Division of Pediatric Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Chrysanthy Ikonomidou
- Section of Pediatric Neurology, Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Justin Brucker
- Section of Neuroradiology, Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Carol Diamond
- Division of Pediatric Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | | | - Neha Patel
- Division of Pediatric Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
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18
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Abstract
RATIONALE Paraneoplastic syndrome is a very rare syndrome among prostate cancer patients. In particular, paraneoplastic sensorimotor neuropathy has never been reported as a complication of prostatic adenocarcinoma. PATIENT CONCERNS A 75-year-old man who was diagnosed with prostatic adenocarcinoma with multiple metastases received cancer treatment. But, numbness and tingling sensations in both sides of the upper and lower limbs got progressively worse. DIAGNOSESE He was diagnosed with positive anti-Hu antibodies paraneoplastic sensorimotor polyneuropathy caused by prostatic adenocarcinoma. INTERVENTIONS The patient received physical therapy, occupational therapy, and opioid medication during 3 weeks at cancer rehabilitation department during 3 weeks. OUTCOMES There was no improvement in functional outcome in this patient. But, the patient's neuropathic pain was improved by the use of opioid agents. LESSONS This case report is the first to report anti-Hu antibody-positive paraneoplastic sensorimotor neuropathy in a patient with adenocarcinoma of the prostate.
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Affiliation(s)
- Jong Kyoung Choi
- Department of Rehabilitation Medicine, Dong-Eui Medical Center, Busan
| | - Won Jun Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW The sensory neuronopathies are sensory-predominant polyneuropathies that result from damage to the dorsal root and trigeminal sensory ganglia. This review explores the various causes of acquired sensory neuronopathies, the approach to diagnosis, and treatment. RECENT FINDINGS Diagnostic criteria have recently been published and validated to allow differentiation of sensory neuronopathies from other polyneuropathies. On the basis of serial electrodiagnostic studies, the treatment window for the acquired sensory neuronopathies has been identified as approximately 8 months. If treatment is initiated within 2 months of symptom onset, there is a better opportunity for improvement of the patient's condition. Even though sensory neuronopathies are rare, significant progress has been made regarding characterization of their clinical, electrophysiologic, and imaging features. This does not hold true, however, for treatment. There have been no randomized controlled clinical trials to guide management of these diseases, and a standard treatment approach remains undetermined.
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Affiliation(s)
- Allison Crowell
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Kelly G Gwathmey
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA.
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20
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Gera A, Kamson DO, Villaflor VM, Lukas RV. Added diagnostic utility of PET in a patient with subacute encephalopathy and small-cell lung cancer. Lung Cancer Manag 2017; 6:9-16. [PMID: 30643565 DOI: 10.2217/lmt-2016-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of paraneoplastic neurologic disorder (PND) synthesizes the clinical picture (including the temporal relationship to the cancer diagnosis), detection of onconeural antibodies and exclusion of alternative causes. The mainstay of brain imaging of PNDs is MRI. There is also an increasingly recognized role of PET using radiotracer 18F-Fluorodeoxyglucose (FDG) in the evaluation of the brain. We describe a 67-year-old female with a 50-year smoking history and small-cell lung cancer developing subacute encephalopathy with MRI and PET abnormalities identifying paraneoplastic encephalitis. PET may complement conventional tools in diagnosing a subset of patients with PND.
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Affiliation(s)
- Anjali Gera
- Department of Neurology, University of Chicago, Chicago, Illinois, USA.,Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - David Olayinka Kamson
- Department of Neurology, University of Chicago, Chicago, Illinois, USA.,Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Victoria M Villaflor
- Section of Hematology & Oncology, Northwestern University, Chicago, Illinois, USA.,Section of Hematology & Oncology, Northwestern University, Chicago, Illinois, USA
| | - Rimas V Lukas
- Department of Neurology, University of Chicago, Chicago, Illinois, USA.,Department of Neurology, University of Chicago, Chicago, Illinois, USA
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21
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Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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22
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Vandenbussche N, Cassiman C, Schrooten M, Gille B, Bossuyt X, Vincent T, Van Damme P, Poesen K. Negative commercial screening test for paraneoplastic antibodies in a case of opsoclonus. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e329. [PMID: 28203618 PMCID: PMC5292927 DOI: 10.1212/nxi.0000000000000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/13/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Nicolas Vandenbussche
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Catherine Cassiman
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Maarten Schrooten
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Benjamin Gille
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Thierry Vincent
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Philip Van Damme
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
| | - Koen Poesen
- Department of Neurology (N.V., M.S., P.V.D.), Department of Ophthalmology (C.C.), and Laboratory Medicine (X.B., K.P.), University Hospital Leuven; Department of Microbiology and Immunology (X.B.), Experimental Laboratory Immunology, Leuven, Belgium; Department of Immunology (T.V.), St Eloi Hospital, Montpellier University, France; Department of Neurosciences (P.V.D.), Laboratory for Neurobiology; Vesalius Research Center (P.V.D.), Flemish Institute for Biotechnology (VIB); and Department of Neurosciences (B.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven, Belgium
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23
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Lee SK, Lee ST. The Laboratory Diagnosis of Autoimmune Encephalitis. J Epilepsy Res 2016; 6:45-50. [PMID: 28101474 PMCID: PMC5206099 DOI: 10.14581/jer.16010] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/16/2016] [Indexed: 12/20/2022] Open
Abstract
Autoimmune encephalitis is a group of encephalitis syndromes that cause altered mentality, memory decline, or seizures in association with the presence of serum and cerebrospinal fluid (CSF) autoantibodies (auto-Abs). An early diagnosis enables early treatments. The detection of auto-Abs is a confirmatory diagnosis. Tissue-based assay, cell-based immunoassay, and immunoblotting are used to detect various autoantibodies. The CSF test for the presence of antibodies is important because it is more sensitive and reflects disease activity in many autoimmune encephalitis, although antibody tests can be negative even in the presence of autoimmune encephalitis. EEG is often abnormal, but nonspecific. A unilateral or bilateral medial temporal T2 high signal is a common finding in MRI. Fludeoxyglucose-positron emission tomography is sometimes useful for diagnosis in patients with normal MRI.
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Affiliation(s)
- Sang Kun Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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24
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Gupta HV, Gervais C, Ross MA, Mehta SH. Purkinje Cell Cytoplasmic Antibody (PCA-2)-related Chorea-Dystonia Syndrome. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:420. [PMID: 27708984 PMCID: PMC5039950 DOI: 10.7916/d8sx6dfj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 08/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Harsh V Gupta
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Mark A Ross
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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25
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Tada S, Furuta M, Fukada K, Hirozawa D, Matsui M, Aoike F, Okuno T, Sawada JI, Mochizuki H, Hazama T. Severe parkinsonism associated with anti-CRMP5 antibody-positive paraneoplastic neurological syndrome and abnormal signal intensity in the bilateral basal ganglia. J Neurol Neurosurg Psychiatry 2016; 87:907-10. [PMID: 26374701 PMCID: PMC4975827 DOI: 10.1136/jnnp-2015-311569] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/26/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Satoru Tada
- INSERM UMR1169 CEA/MIRCen, Fontenay aux Roses, France Department of Neurology, Osaka General Medical Center, Osaka, Japan
| | - Mitsuru Furuta
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kei Fukada
- Department of Neurology, Osaka General Medical Center, Osaka, Japan
| | - Daisuke Hirozawa
- Department of Neurology, Shizuoka Institute of Epilepsy and Neurological Disorders, National Hospital Organization, Shizuoka, Japan
| | - Misa Matsui
- Department of Neurology, National Toneyama Hospital, National Hospital Organization, Toyonaka, Japan
| | - Futoshi Aoike
- Department of Neurology, Tane General Hospital, Osaka, Japan
| | - Tatsusada Okuno
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jin-Ichi Sawada
- Department of Neurology, Osaka General Medical Center, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takanori Hazama
- Department of Neurology, Osaka General Medical Center, Osaka, Japan
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26
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Fraune J, Gerlach S, Rentzsch K, Teegen B, Lederer S, Affeldt K, Fechner K, Danckwardt M, Voigt J, Probst C, Komorowski L, Stöcker W. Multiparametric serological testing in autoimmune encephalitis using computer-aided immunofluorescence microscopy (CAIFM). Autoimmun Rev 2016; 15:937-42. [PMID: 27490202 DOI: 10.1016/j.autrev.2016.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 12/30/2022]
Abstract
Autoantibodies against neuronal cell surface antigens are tightly associated with immunotherapy-responsive autoimmune encephalitis, and a considerable number of corresponding autoantigens has been identified in recent years. Most patients initially present with overlapping symptoms, and a broad range of autoantibodies has to be considered to establish the correct diagnosis and initiate treatment as soon as possible to prevent irreversible and sometimes even life-threatening damage to the brain. Recombinant cell-based immunofluorescence allows to authentically present fragile membrane-associated surface antigens and, in combination with multiparametric analysis in the form of biochip mosaics, has turned out to be highly beneficial for parallel and prompt determination of anti-neuronal autoantibodies and comprehensive differential diagnostics. For the evaluation of recombinant cell-based IIFT, a semi-automated novel function was introduced into an established platform for computer-aided immunofluorescence microscopy. The system facilitates the microscopic analysis of the tests and supports the laboratory personnel in the rapid issuance of diagnostic findings, which is of major importance for autoimmune encephalitis patients since timely initiation of treatment may lead to their full recovery.
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Affiliation(s)
- Johanna Fraune
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Stefan Gerlach
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Kristin Rentzsch
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Bianca Teegen
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Sabine Lederer
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Kai Affeldt
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Kai Fechner
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Maick Danckwardt
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Jörn Voigt
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Christian Probst
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Lars Komorowski
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Winfried Stöcker
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany.
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27
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Scheer S, John RM. Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Children and Adolescents. J Pediatr Health Care 2016; 30:347-58. [PMID: 26507948 DOI: 10.1016/j.pedhc.2015.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 12/18/2022]
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that is becoming increasingly recognized in the pediatric population. It may be the most common cause of treatable autoimmune encephalitis. The majority of cases of anti-NMDAR encephalitis are idiopathic in etiology, but a significant minority can be attributed to a paraneoplastic origin. Children with anti-NMDAR encephalitis initially present with a prodrome of neuropsychiatric symptoms, often with orofacial dyskinesias followed by progressively worsening seizures, agitation, and spasticity, which may result in severe neurologic deficits and even death. Definitive diagnosis requires detection of NMDAR antibodies in the cerebrospinal fluid. Optimal outcomes are associated with prompt removal of the tumor in paraneoplastic cases, as well as aggressive immunosuppressive therapy. Early detection is essential for increasing the chances for a good outcome. Close follow-up is required to screen for relapse and later onset tumor presentation. The nurse practitioner plays a major role in the research, screening, diagnosis, treatment, follow-up, and rehabilitation of a child or adolescent with anti-NMDAR encephalitis.
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28
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Kinzel S, Lehmann-Horn K, Torke S, Häusler D, Winkler A, Stadelmann C, Payne N, Feldmann L, Saiz A, Reindl M, Lalive PH, Bernard CC, Brück W, Weber MS. Myelin-reactive antibodies initiate T cell-mediated CNS autoimmune disease by opsonization of endogenous antigen. Acta Neuropathol 2016; 132:43-58. [PMID: 27022743 PMCID: PMC4911382 DOI: 10.1007/s00401-016-1559-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/05/2016] [Accepted: 03/05/2016] [Indexed: 12/15/2022]
Abstract
In the pathogenesis of central nervous system (CNS) demyelinating disorders, antigen-specific B cells are implicated to act as potent antigen-presenting cells (APC), eliciting waves of inflammatory CNS infiltration. Here, we provide the first evidence that CNS-reactive antibodies (Ab) are similarly capable of initiating an encephalitogenic immune response by targeting endogenous CNS antigen to otherwise inert myeloid APC. In a transgenic mouse model, constitutive production of Ab against myelin oligodendrocyte glycoprotein (MOG) was sufficient to promote spontaneous experimental autoimmune encephalomyelitis (EAE) in the absence of B cells, when mice endogenously contained MOG-recognizing T cells. Adoptive transfer studies corroborated that anti-MOG Ab triggered activation and expansion of peripheral MOG-specific T cells in an Fc-dependent manner, subsequently causing EAE. To evaluate the underlying mechanism, anti-MOG Ab were added to a co-culture of myeloid APC and MOG-specific T cells. At otherwise undetected concentrations, anti-MOG Ab enabled Fc-mediated APC recognition of intact MOG; internalized, processed and presented MOG activated naïve T cells to differentiate in an encephalitogenic manner. In a series of translational experiments, anti-MOG Ab from two patients with an acute flare of CNS inflammation likewise facilitated detection of human MOG. Jointly, these observations highlight Ab-mediated opsonization of endogenous CNS auto-antigen as a novel disease- and/or relapse-triggering mechanism in CNS demyelinating disorders.
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Affiliation(s)
- Silke Kinzel
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Klaus Lehmann-Horn
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München and Munich Cluster for Systems Neurology, Munich, Germany
| | - Sebastian Torke
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Darius Häusler
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Anne Winkler
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Christine Stadelmann
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Natalie Payne
- Monash Regenerative Medicine Institute, Multiple Sclerosis Research Group, Monash University, Melbourne, Australia
| | - Linda Feldmann
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Albert Saiz
- Service of Neurology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrice H Lalive
- Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Claude C Bernard
- Monash Regenerative Medicine Institute, Multiple Sclerosis Research Group, Monash University, Melbourne, Australia
| | - Wolfgang Brück
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany
| | - Martin S Weber
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany.
- Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany.
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhu Y, Chen S, Chen S, Song J, Chen F, Guo H, Shang Z, Wang Y, Zhou C, Shi B. An uncommon manifestation of paraneoplastic cerebellar degeneration in a patient with high grade urothelial, carcinoma with squamous differentiation: A case report and literature review. BMC Cancer 2016; 16:324. [PMID: 27209351 PMCID: PMC4875707 DOI: 10.1186/s12885-016-2349-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 05/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background Paraneoplastic neurological syndromes (PNS) are rare disorders associated with malignant tumours, which are triggered by autoimmune reactions. Paraneoplastic cerebellar degeneration (PCD) is the PNS type most commonly associated with ovarian and breast cancer. Two bladder cancers manifesting in PCD were previously reported. However, the cancers in these cases had poor outcomes. Case presentation Here, we present a 68-year old man with history of high-grade papillary urothelial carcinoma of the bladder. The patient suffered from persistent cerebellar ataxia accompanied by bladder cancer recurrence five months after transurethral resection of the bladder tumour (TURBt). Laboratory screening for the specific antibodies of paraneoplastic neurological syndromes revealed no positive results. Symptoms were not remitted after a 7-day-course of high-dose glucocorticoid therapy. To our surprise, the patient recovered fully after laparoscopic radical cystectomy. Postoperative pathology revealed that surgical specimens were urothelial carcinoma in situ (CIS) and squamous cell carcinoma of the bladder. The patient remained asymptomatic and there was no evidence of recurrence after the followup period of 11 months. Conclusion To our knowledge, this is the third report of PCD in a patient with bladder cancer. This case showed that tumour resection cured the PCD. To assist clinical evaluation and management, literature regarding basic PNS characteristics and bladder cancers was reviewed.
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Affiliation(s)
- Yaofeng Zhu
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Songyu Chen
- Department of Neurosurgery, Shanghai tenth people's Hospital, Tongji University, Yanchang Zhong Road, Shanghai, People's Republic of China
| | - Jing Song
- Shandong University School of Medicine, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Fan Chen
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Hu Guo
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Zhenhua Shang
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Yong Wang
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Changkuo Zhou
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Wenhua Xi Road, Jinan, Shandong Province, People's Republic of China.
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Kasi PM, Hieken TJ, Haddad TC. Unilateral Arm Urticaria Presenting as a Paraneoplastic Manifestation of Metachronous Bilateral Breast Cancer. Case Rep Oncol 2016; 9:33-8. [PMID: 26933416 PMCID: PMC4748789 DOI: 10.1159/000443661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Various paraneoplastic syndromes (PNS) are reported to be associated with breast cancer and can range from mild dermatological symptoms to severe neurological complications. Neurological and dermatological manifestations tend to be the more commonly seen paraneoplastic manifestations, albeit both are relatively rare. Diagnosis of the underlying malignancy is often delayed since the presence and severity of paraneoplastic manifestations are not dependent on the tumor size or stage. Herein, we describe a unique case of unilateral arm urticaria presenting as a paraneoplastic manifestation of metachronous bilateral breast cancer. Similar reports and other PNS associated with breast cancer are described. Recognition of PNS associated with underlying malignancies and age-appropriate screening can facilitate diagnosis of the underlying occult malignancy. Resection of the underlying malignancy can lead to resolution and/or improvement of the PNS for some patients.
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Affiliation(s)
- Pashtoon Murtaza Kasi
- Department of Oncology, Mayo Clinic, College of Medicine, Mayo Clinic, Rochester, Minn., USA
| | - Tina J Hieken
- Department of Surgery, College of Medicine, Mayo Clinic, Rochester, Minn., USA
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, College of Medicine, Mayo Clinic, Rochester, Minn., USA
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Affiliation(s)
- Kelly Graham Gwathmey
- Department of Neurology; University of Virginia; P.O. Box 800394 Charlottesville Virginia 22908 USA
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Harrison JW, Cherukuri R, Buchan D. Renal Cell Carcinoma Presenting with Paraneoplastic Hallucinations and Cognitive Decline from Limbic Encephalitis. J Gen Intern Med 2015; 30:1037-40. [PMID: 25608740 PMCID: PMC4471013 DOI: 10.1007/s11606-014-3172-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/16/2014] [Accepted: 12/29/2014] [Indexed: 12/14/2022]
Abstract
We present a 66-year-old woman with 2 months of visual hallucinations, unintentional weight loss, and short-term memory decline, whose clinical presentation and EEG supported a diagnosis of limbic encephalitis. Subsequent evaluation for a paraneoplastic etiology revealed a renal mass, which was resected and identified as clear cell renal carcinoma. The patient's clinical condition improved after resection of the mass. When patients present with incongruous subacute neuropsychiatric symptoms, clinicians should be mindful of paraneoplastic neurological disorders, as early diagnosis and treatment of malignancy may lead to symptomatic improvement.
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Affiliation(s)
- Joshua W Harrison
- Department of Internal Medicine, Upstate Medical University, 750 East Adams St., Syracuse, NY, 13210, USA,
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Abstract
PURPOSE OF REVIEW This article provides an approach to the recognition and management of paraneoplastic neuropathies. RECENT FINDINGS Paraneoplastic neuropathies may have unique phenotypic presentations, such as sensory neuronopathy, autonomic enteric neuropathy, demyelinating neuropathy, and, rarely, motor neuropathy. Paraneoplastic sensorimotor neuropathy, on the other hand, may be indistinguishable from other common types of axonal polyneuropathy. Certain patterns of neuropathies are commonly seen with different types of cancers, but this relationship is not exclusive and not all patients whose pattern of neuropathy suggests a paraneoplastic disorder have an underlying cancer. In addition to definitive therapy for malignancy, immunomodulatory therapy, such as corticosteroids, IV immunoglobulin (IVIg), or immunosuppressants, may benefit some patients, but there are very few published treatment data for paraneoplastic neuropathies. SUMMARY Prompt recognition of paraneoplastic neuropathies may lead to identification and treatment of an occult cancer. Treatment can potentially arrest the progression of neuropathy.
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Abstract
Paraneoplastic disorders of the nervous system (PNDs) are rare and unique disorders, where a specific pattern of neural damage occurs as a side effect of the interaction between the neoplasm and the host immune response. Clinical recognition of PNDs may be challenging but can lead to early detection of an occult neoplasm. Their study may lead to a better understanding of nervous system autoimmunity and even to devising novel immunotherapies against certain tumor types. Familiarity with the clinical syndromes, neuroradiological findings, autoantibodies, and tissue responses associated with PND may help arrive at a correct diagnosis in most cases.
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Affiliation(s)
- S Humayun Gultekin
- Department of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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36
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Martel S, De Angelis F, Lapointe E, Larue S, Speranza G. Paraneoplastic neurologic syndromes: Clinical presentation and management. Curr Probl Cancer 2014; 38:115-34. [DOI: 10.1016/j.currproblcancer.2014.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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de Jongste AHC, van Rosmalen J, Gratama JW, Sillevis Smitt PAE. Current and future approaches for treatment of paraneoplastic neurological syndromes with well-characterized onconeural antibodies. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.903796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Cancer-associated immune-mediated disorders of the central nervous system are a heterogeneous group. These disorders include the classic paraneoplastic neurologic disorders and the more recently described autoimmune encephalitis associated with antibodies to neuronal cell-surface or synaptic receptors that occur with and without a cancer association. Autoimmune encephalitis is increasingly recognized as the cause of a variety of neuropsychiatric syndromes that can be severe and prolonged. In contrast to the classic paraneoplastic disorders that are poorly responsive to tumor treatment and immunotherapy, autoimmune encephalitis often responds to these treatments, and patients can have full or marked recoveries. As early treatment speeds recovery, reduces disability, and decreases relapses that can occur in about 20% of cases, it is important that the immune pathogenesis of these disorders is recognized.
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Affiliation(s)
- Josep Dalmau
- Institució Catalana de Recerca i Estudis Avançats (ICREA) at Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain (J.D.); Hospital Clínic/IDIBAPS, Department of Neurology, Barcelona, Spain (M.R.R.)
| | - Myrna R Rosenfeld
- Institució Catalana de Recerca i Estudis Avançats (ICREA) at Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain (J.D.); Hospital Clínic/IDIBAPS, Department of Neurology, Barcelona, Spain (M.R.R.)
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van Coevorden-Hameete MH, de Graaff E, Titulaer MJ, Hoogenraad CC, Sillevis Smitt PAE. Molecular and cellular mechanisms underlying anti-neuronal antibody mediated disorders of the central nervous system. Autoimmun Rev 2014; 13:299-312. [PMID: 24225076 DOI: 10.1016/j.autrev.2013.10.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 10/30/2013] [Indexed: 12/31/2022]
Abstract
Over the last decade multiple autoantigens located on the plasma membrane of neurons have been identified. Neuronal surface antigens include molecules directly involved in neurotransmission and excitability. Binding of the antibody to the antigen may directly alter the target protein's function, resulting in neurological disorders. The often striking reversibility of symptoms following early aggressive immunotherapy supports a pathogenic role for autoantibodies to neuronal surface antigens. In order to better understand and treat these neurologic disorders it is important to gain insight in the underlying mechanisms of antibody pathogenicity. In this review we discuss the clinical, circumstantial, in vitro and in vivo evidence for neuronal surface antibody pathogenicity and the possible underlying cellular and molecular mechanisms. This review shows that antibodies to neuronal surface antigens are often directed at conformational epitopes located in the extracellular domain of the antigen. The conformation of the epitope can be affected by specific posttranslational modifications. This may explain the distinct clinical phenotypes that are seen in patients with antibodies to antigens that are expressed throughout the brain. Furthermore, it is likely that there is a heterogeneous antibody population, consisting of different IgG subtypes and directed at multiple epitopes located in an immunogenic region. Binding of these antibodies may result in different pathophysiological mechanisms occurring in the same patient, together contributing to the clinical syndrome. Unraveling the predominant mechanism in each distinct antigen could provide clues for therapeutic interventions.
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Affiliation(s)
- M H van Coevorden-Hameete
- Department of Biology, Division of Cell Biology, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands.
| | - E de Graaff
- Department of Biology, Division of Cell Biology, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands.
| | - M J Titulaer
- Department of Neurology, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - C C Hoogenraad
- Department of Biology, Division of Cell Biology, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands.
| | - P A E Sillevis Smitt
- Department of Neurology, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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