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Lizwan M, Lin SZZ, Sonu SK. Rare case of anti-CV2 paraneoplastic polyneuropathy associated with lung adenocarcinoma. BMJ Case Rep 2023; 16:e253686. [PMID: 36737068 PMCID: PMC9900051 DOI: 10.1136/bcr-2022-253686] [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] [Indexed: 02/05/2023] Open
Abstract
We describe the first case of anti-CV2 paraneoplastic polyneuropathy associated with lung adenocarcinoma. Our patient presented with progressive unsteadiness and numbness involving bilateral upper and lower limbs. He had symmetrical length-dependent lower motor neuron pattern of weakness and numbness involving both small and large fibres with prominent sensory ataxia. An extended workup for the polyneuropathy involving a serum paraneoplastic antineuronal antibody panel showed a positive reaction for anti-CV2 antibody. CT scan of the thorax, abdomen and pelvis revealed a right upper lung nodule and histopathological examination of the nodule revealed lung adenocarcinoma. He was scheduled for chemotherapy following his discharge and there was improvement of his sensorimotor polyneuropathy following his chemotherapy.
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Affiliation(s)
| | - Shawn Zhi Zheng Lin
- Department of Neurology, National Neuroscience Institute - Singapore General Hospital Campus, Singapore
| | - Sumit Kumar Sonu
- Department of Neurology, National Neuroscience Institute - Singapore General Hospital Campus, Singapore
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2
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Alberto T, Honnorat J, Joubert B. Sindromi neurologiche paraneoplastiche. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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3
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Abstract
Pituitary autoimmunity is one of the principal causes of hypopituitarism. Additionally, hypophysitis is one of the immune-related adverse events associated with immunotherapy. Recent case-oriented research has revealed a novel type of autoimmune hypophysitis, anti-PIT-1 hypophysitis, related to isolated adrenocorticotropic hormone (ACTH) deficiency and immune checkpoint inhibitor-related hypophysitis, as a form of paraneoplastic syndrome. Under these conditions, the ectopic expression of pituitary antigens present in tumors evokes a breakdown of immune tolerance, resulting in the production of autoantibodies and autoreactive cytotoxic T cells that specifically harm pituitary cells. Consequently, an innovative clinical entity of paraneoplastic autoimmune hypophysitis has been purported. This novel concept and its underlying mechanisms provide clues for understanding the pathogenesis of autoimmune pituitary diseases and can be applied to other autoimmune diseases. This review discusses the etiology of paraneoplastic autoimmune hypophysitis and its future.
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Affiliation(s)
- Hironori Bando
- Division of Development of Advanced Therapy for Metabolic Diseases, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Keitaro Kanie
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan.
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4
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Tolkovsky A, Kipervasser S, Fainmesser Y, Alcalay Y, Gadoth A. A paraneoplastic syndrome misdiagnosed as ALS: What are the red flags? A case report and review of the literature. J Neuroimmunol 2021; 358:577635. [PMID: 34217018 DOI: 10.1016/j.jneuroim.2021.577635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 12/11/2022]
Abstract
Background Paraneoplastic motor neuron disease (PMND) is a rare, non-classical form of paraneoplastic neurological syndrome (PNS). Anti-Hu and anti-CV2/CRMP5 PNS are mostly associated with small-cell lung cancer (SCLC) and consist of highly variable clinical syndromes, including sensory neuronopathy, cerebellar ataxia and/or limbic encephalitis. However, substantial motor impairment is uncommon, particularly when no sensory dysfunction co-exists. Case A 72-year-old man with a recent diagnosis of amyotrophic lateral sclerosis (ALS) was referred to our department of neurology for evaluation. The patient sub-acutely developed progressive neurological dysfunction including erectile dysfunction, behavioral changes, limb weakness, dysphagia, anorexia, as well as worsening stridor that necessitated tracheostomy due to bilateral vocal cord paralysis (BVCP). Neurological examination revealed motor weakness of upper and lower motor neuron origin with autonomic and cognitive dysfunction. Cerebrospinal fluid (CSF) analysis demonstrated pleocytosis, elevated protein, presence of oligoclonal bands (OCB), and neuronal antibody testing was positive for anti-Hu and anti-CV2/CRMP5. Based on these findings a diagnosis of a PNS was made. Evaluation for malignancy was negative, and immunosuppressive/immunomodulatory treatment was initiated but had little effect during fifteen months of follow-up. Conclusions Although PMND is very rare, in an atypical presentation, especially with features that are not usually present in ALS such as autonomic dysfunction, sensory disturbance or cognitive decline, this etiology should be in the differential diagnosis.
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Affiliation(s)
- Assaf Tolkovsky
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Svetlana Kipervasser
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Epilepsy Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaara Fainmesser
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuromuscular Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Alcalay
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Immunology Laboratory, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Gadoth
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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5
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Abstract
Introduction: Paraneoplastic neurological syndromes (PNS) are a rare heterogeneous group of neurological diseases associated with tumors. These syndromes are the result of a cross-reactive immune response against antigens shared by the tumor and the nervous system. The discovery of an increasing number of autoantigens and the identification of tumoral factors leading to a substantial antitumoral immune response makes this topic highly innovative.Areas covered: This review covers the clinical, oncological, pathophysiological aspects of both immunological PNS groups. One is associated with autoantibodies against intracellular onconeural antibodies, which are highly specific for an underlying tumor, although the disease is mainly T-cell mediated. In contrast, PNS associated with pathogenic surface-binding/receptor autoantibodies, which are often responsive to immunosuppressive treatment, may manifest as paraneoplastic and non-paraneoplastic diseases. The most frequent tumors associated with PNS are (small cell) lung cancer, gynecological tumors, thymoma, lymphoma, and, in children, neuroblastoma. A special interest is given to PNS, induced by immune checkpoint-inhibitors (ICIs).Expert opinion: Research in PNS, including the group of ICI-induced PNS provide new insights in both the pathophysiology of PNS and tumor immune interactions and offers new treatment options for this group of severe neurological diseases.
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Affiliation(s)
- Franz Blaes
- Department of Neurology, KKH Gummersbach, Gummersbach, Germany
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6
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Soomro Z, Youssef M, Yust-Katz S, Jalali A, Patel AJ, Mandel J. Paraneoplastic syndromes in small cell lung cancer. J Thorac Dis 2020; 12:6253-6263. [PMID: 33209464 PMCID: PMC7656388 DOI: 10.21037/jtd.2020.03.88] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Paraneoplastic syndromes can commonly occur due to lung cancer, especially small cell lung cancer. Frequently paraneoplastic syndromes can precede the diagnosis of the neoplasm or present with limited stage disease. However, these syndromes can also occur at the time of recurrence or metastasis of disease. This review focuses on the epidemiology, pathogenesis, clinical features, and current management of the most common paraneoplastic syndromes encountered in patients with small cell lung cancer. Manifestations of paraneoplastic syndromes in small cell lung cancer include endocrine syndromes with secretion of excess hormones, and neurologic syndromes due to the production of antibodies causing an autoimmune condition. Recent advances have allowed for greater understanding of these syndromes and for the development of improved diagnostic as well as therapeutic tools. Awareness of paraneoplastic syndromes in small cell lung cancer can lead to an earlier diagnosis and recognition of both the condition and in some cases the disease potentially improving the overall survival and prognosis for patients. Further research examining effective methods to improve recovery from neurologic deficits in patients with a paraneoplastic neurologic illness is warranted.
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Affiliation(s)
- Zaid Soomro
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Youssef
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ali Jalali
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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7
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Tholance Y, Moritz CP, Rosier C, Ferraud K, Lassablière F, Reynaud-Federspiel E, França MC, Martinez ARM, Camdessanché JP, Antoine JC. Clinical characterisation of sensory neuropathy with anti-FGFR3 autoantibodies. J Neurol Neurosurg Psychiatry 2020; 91:49-57. [PMID: 31690697 DOI: 10.1136/jnnp-2019-321849] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Sensory neuropathies (SNs) are often classified as idiopathic even if immunological mechanisms can be suspected. Antibodies against the intracellular domain of the fibroblast growth factor receptor 3 (FGFR3) possibly identify a subgroup of SN affecting mostly the dorsal root ganglion (DRG). The aim of this study was to identify the frequency of anti-FGFR3 antibodies and the associated clinical pattern in a large cohort of patients with SN. METHODS A prospective, multicentric, European and Brazilian study included adults with pure SN. Serum anti-FGRF3 antibodies were analysed by ELISA. Detailed clinical and paraclinical data were collected for each anti-FGFR3-positive patient and as control for anti-FGFR3-negative patients from the same centres ('center-matched'). RESULTS Sixty-five patients out of 426 (15%) had anti-FGFR3 antibodies, which were the only identified autoimmune markers in 43 patients (66%). The neuropathy was non-length dependent in 89% and classified as sensory neuronopathy in 64%, non-length-dependent small fibre neuropathy in 17% and other neuropathy in 19%. Specific clinical features occurred after 5-6 years of evolution including frequent paresthesia, predominant clinical and electrophysiological involvement of the lower limbs, and a less frequent mixed large and small fibre involvement. Brazilians had a higher frequency of anti-FGFR3 antibodies than Europeans (36% vs 13%, p<0.001), and a more frequent asymmetrical distribution of symptoms (OR 169, 95% CI 3.4 to 8424). CONCLUSIONS Anti-FGFR3 antibodies occur in a subgroup of SN probably predominantly affecting the DRG. Differences between Europeans and Brazilians could suggest involvement of genetic or environmental factors.
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Affiliation(s)
- Yannick Tholance
- Laboratory of Biochemistry, CHU Saint-Etienne, Saint-Etienne, France .,Synaptopathies et autoanticorps (synatac), Institut Neuromyogène, Saint-Priest-en-Jarez, France
| | - Christian Peter Moritz
- Synaptopathies et autoanticorps (synatac), Institut Neuromyogène, Saint-Priest-en-Jarez, France
| | - Carole Rosier
- Synaptopathies et autoanticorps (synatac), Institut Neuromyogène, Saint-Priest-en-Jarez, France.,Department of Neurology, CHU Saint-Etienne, Saint-Etienne, France
| | - Karine Ferraud
- Department of Neurology, CHU Saint-Etienne, Saint-Etienne, France
| | - François Lassablière
- Synaptopathies et autoanticorps (synatac), Institut Neuromyogène, Saint-Priest-en-Jarez, France
| | | | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Alberto R M Martinez
- Department of Neurology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Jean-Philippe Camdessanché
- Synaptopathies et autoanticorps (synatac), Institut Neuromyogène, Saint-Priest-en-Jarez, France.,Department of Neurology, CHU Saint-Etienne, Saint-Etienne, France
| | - Jean-Christophe Antoine
- Synaptopathies et autoanticorps (synatac), Institut Neuromyogène, Saint-Priest-en-Jarez, France.,Department of Neurology, CHU Saint-Etienne, Saint-Etienne, France
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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: 782] [Impact Index Per Article: 156.4] [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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9
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Siles AM, Martínez‐Hernández E, Araque J, Diaz‐Manera J, Rojas‐Garcia R, Gallardo E, Illa I, Graus F, Querol L. Antibodies against cell adhesion molecules and neural structures in paraneoplastic neuropathies. Ann Clin Transl Neurol 2018; 5:559-569. [PMID: 29761119 PMCID: PMC5945957 DOI: 10.1002/acn3.554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 12/16/2022] Open
Abstract
Objective Paraneoplastic neurological syndromes (PNS) are rare neurological disorders in which ectopic expression of neural antigens by a tumor results in an autoimmune attack against the nervous system. Onconeural antibodies not only guide PNS diagnosis but may also help detecting underlying malignancies. Our project aims to uncover new potential antibodies in paraneoplastic neuropathies (PN). Methods Thirty‐four patients fulfilling diagnostic criteria of possible (n = 9; 26.5%) and definite (n = 25; 73.5%) PN without onconeural antibodies and 28 healthy controls were included in our study. Sera were tested for known antibodies against neural cell adhesion molecules and screened for novel IgG and IgM reactivities against nerve components: dorsal root ganglia (DRG) neurons, motor neurons, and Schwann cells. Patients showing autoantibodies against any of these cell types were used for immunoprecipitation (IP) studies. Results Overall, 9 (26.5%) patients showed significant reactivity against DRG neurons, motor neurons, or Schwann cells, whereas 5 (17.9%) healthy controls only showed moderate reactivity. Compared with control sera, serum samples from patients with paraneoplastic sensory‐motor neuropathies had a higher frequency of IgM antibodies against Schwann cells (0% vs. 40%; P = 0.0028). No novel antigens were identified from our IP experiments. Antibodies against the neural adhesion molecules CNTN1, NF155, NF140, NF186, NCAM1, L1CAM, and the CNTN1/CASPR1 complex were not detected in patients with PN. One (2.9%) patient with CIDP and thymoma had CASPR2 antibodies. Interpretation Almost 30% of patients with PN harbor antibodies targeting neural structures, suggesting that novel neoplasm‐associated antigens remain to be discovered.
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Affiliation(s)
- Ana M. Siles
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Eugenia Martínez‐Hernández
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
- Service of Neurology and NeuroimmunologyAugust Pi Sunyer Biomedical Research Institute (IDIBAPS)Hospital ClínicUniversity of BarcelonaSpain
| | - Josefa Araque
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Jordi Diaz‐Manera
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Ricard Rojas‐Garcia
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Eduard Gallardo
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Isabel Illa
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| | - Francesc Graus
- Service of Neurology and NeuroimmunologyAugust Pi Sunyer Biomedical Research Institute (IDIBAPS)Hospital ClínicUniversity of BarcelonaSpain
| | - Luis Querol
- Neuromuscular Diseases UnitNeurology DepartmentHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
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11
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McKinnon C, Manchanda S. A case of confusion: paraneoplastic encephalomyelitis in an elderly patient suspected of having urinary tract infection-associated delirium. BMJ Case Rep 2017; 2017:bcr-2016-218088. [PMID: 28546233 DOI: 10.1136/bcr-2016-218088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients, however, neurological decline is progressive, raising concern about a serious underlying cause. We describe the case of a 71-year-old woman who developed progressive cognitive impairment following insertion of a permanent pacemaker for sinoatrial arrests. An initial diagnosis of delirium secondary to a urinary tract infection was suspected; however, the patient became increasingly confused despite treatment. Laboratory tests revealed serum anti-Hu paraneoplastic antibodies, and CT chest identified an occult lung tumour. Cervical lymph node histopathology confirmed a diagnosis of small cell carcinoma of the lung. Although a rare cause of confusion, paraneoplastic encephalomyelitis should be recognised early to allow timely identification and treatment of the associated cancer.
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Affiliation(s)
- Chris McKinnon
- Division of Integrated Elderly Medicine & Community Care, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK
| | - Simmie Manchanda
- Division of Integrated Elderly Medicine & Community Care, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK
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12
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Sæther SG, Schou M, Kondziella D. What is the significance of onconeural antibodies for psychiatric symptomatology? A systematic review. BMC Psychiatry 2017; 17:161. [PMID: 28468645 PMCID: PMC5415831 DOI: 10.1186/s12888-017-1325-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/24/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with intracellular onconeural antibodies may present with neuro-psychiatric syndromes. We aimed to evaluate the evidence for an association between well-characterized onconeural antibodies and psychiatric symptoms in patients with and without paraneoplastic central nervous system syndromes. METHODS Eligible studies were selected from 1980 until February 2017 according to standardized review criteria and evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). We included studies describing the psychiatric symptomatology of onconeural antibody positive patients and the prevalence of onconeural antibodies in patients with psychiatric disorders. RESULTS Twenty-seven studies met the inclusion criteria. Six studies reported on the prevalence of well-characterized onconeural antibodies in patients with different psychiatric disorders, ranging from 0% to 4.9%. Antibody prevalence in controls was available from three studies, ranging from 0% to 2.8%. Data heterogeneity precluded a meta-analysis. Two cerebrospinal fluid studies found well-characterized onconeural antibodies in 3.5% and 0% of patients with psychotic and depressive syndromes, respectively. CONCLUSIONS The available evidence suggests that the prevalence of well-characterized onconeural antibodies in patients with psychiatric disorders is generally low. However, the question whether onconeural antibodies are important in select patients with a purely psychiatric phenotype needs to be addressed by appropriately designed studies in the future.
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Affiliation(s)
- Sverre Georg Sæther
- Department of Psychiatry, St. Olav's University Hospital, Pb. 3008, Lade, 7441, Trondheim, Norway. .,Department of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Pb. 8905, 7491, Trondheim, Norway.
| | - Morten Schou
- 0000 0004 0627 3560grid.52522.32Department of Psychiatry, St. Olav’s University Hospital, Pb. 3008, Lade, 7441 Trondheim, Norway ,0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Pb. 8905, 7491 Trondheim, Norway
| | - Daniel Kondziella
- 0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Pb. 8905, 7491 Trondheim, Norway ,0000 0004 0646 7373grid.4973.9Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvei 9; DK, -2100 Copenhagen, Denmark
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13
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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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14
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Abstract
Patients with brain tumors and systemic malignancies are subject to diverse neurologic complications that require urgent evaluation and treatment. These neurologic conditions are commonly due to the tumor's direct effects on the nervous system, such as cerebral edema, increased intracranial pressure, seizures, spinal cord compression, and leptomeningeal metastases. In addition, neurologic complications can develop as a result of thrombocytopenia, coagulopathy, hyperviscosity syndromes, infection, immune-related disorders, and adverse effects of treatment. Patients may present with typical disease syndromes. However, it is not uncommon for patients to have more subtle, nonlocalizing manifestations, such as alteration of mental status, that could be attributed to other systemic, nonneurologic complications. Furthermore, neurologic complications are at times the initial manifestations of an undiagnosed malignancy. Therefore a high index of suspicion is essential for rapid assessment and management. Timely intervention may prolong survival and improve quality of life. In this chapter, we will discuss the common neuro-oncologic emergencies, including epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment.
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Affiliation(s)
- J T Jo
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA
| | - D Schiff
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA.
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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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16
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Furlan JC, Robinson LR, Murray BJ. Clinical Reasoning: Stepwise paralysis in a patient with adenocarcinoma of lung. Neurology 2016; 86:e122-7. [PMID: 27001993 DOI: 10.1212/wnl.0000000000002496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Julio C Furlan
- From the Divisions of Neurology (J.C.F., B.J.M.) and Physical Medicine and Rehabilitation (J.C.F., L.R.R.), University of Toronto; Lyndhurst Centre (J.C.F.), Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation (L.R.R.) and Division of Neurology, Department of Medicine (B.J.M.), Sunnybrook Health Sciences Centre, University of Toronto, Canada.
| | - Lawrence R Robinson
- From the Divisions of Neurology (J.C.F., B.J.M.) and Physical Medicine and Rehabilitation (J.C.F., L.R.R.), University of Toronto; Lyndhurst Centre (J.C.F.), Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation (L.R.R.) and Division of Neurology, Department of Medicine (B.J.M.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Brian J Murray
- From the Divisions of Neurology (J.C.F., B.J.M.) and Physical Medicine and Rehabilitation (J.C.F., L.R.R.), University of Toronto; Lyndhurst Centre (J.C.F.), Toronto Rehabilitation Institute, University Health Network; and Division of Physical Medicine and Rehabilitation (L.R.R.) and Division of Neurology, Department of Medicine (B.J.M.), Sunnybrook Health Sciences Centre, University of Toronto, Canada
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Paraneoplastic limbic and extra-limbic encephalitis secondary to a thymoma mimicking an acute stroke. Can J Neurol Sci 2016; 43:420-3. [DOI: 10.1017/cjn.2015.341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Thanarajasingam G, Milone M, Kohli M. Paraneoplastic encephalopathy: an unusual presenting feature of bladder cancer metastasis. BMJ Case Rep 2015; 2015:bcr-2014-208913. [PMID: 25939973 DOI: 10.1136/bcr-2014-208913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 73-year-old woman with a history of localised transitional cell cancer (TCC) of the bladder, resected 22 years prior, presented with tremor, gait unsteadiness and cognitive deficits. Basic neurological workup was negative and CT of the abdomen revealed recurrent TCC with a solitary pelvic metastasis. She was treated with surgical resection of her tumour and immunosuppression. Her symptoms resolved, and it was felt her presentation was consistent with paraneoplastic encephalopathy in the setting of bladder cancer metastasis. She has remained disease and symptom free over 5 years of follow-up. This case report reviews the mechanism, clinical features and treatment of paraneoplastic neurological syndromes, and discusses briefly the management of oligometastatic recurrent bladder cancer.
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Affiliation(s)
| | | | - Manish Kohli
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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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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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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