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Ha J, Na BS, Ahn JH, Kim M, Kim JW, Lee JH, Cho JW, Kim JS, Youn J. Anti-CV2/CRMP5 Paraneoplastic Chorea Effectively Managed with Intravenous Amantadine. Tremor Other Hyperkinet Mov (N Y) 2019; 9:tre-09-701. [PMID: 31656691 PMCID: PMC6790010 DOI: 10.7916/tohm.v0.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Paraneoplastic chorea is typically a subacute progressive hyperkinetic movement disorder. The mainstay of treatment is managing the underlying neoplasm. However, the clinical course may be variable, and effective symptomatic management can precede the start of cancer treatment. CASE REPORT A 63-year-old man presented with insidious onset, slowly progressive generalized chorea for 1 year, later diagnosed as anti-CV2/CRMP5 autoantibody positive paraneoplastic chorea. His chorea was markedly improved with intravenous amantadine. DISCUSSION In patients with anti-CV2/CRMP5 autoantibody-related chorea, sequential follow-up of brain magnetic resonance imaging reveals progression from active inflammation to atrophy. Our report highlights the efficacy of intravenous amantadine in paraneoplastic chorea.
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Affiliation(s)
- Jongmok Ha
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Boo Suk Na
- Department of Neurology, Dongshin Hospital, Seoul, KR
| | - Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Jae Woo Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, KR
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, KR
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KR,Neuroscience Center, Samsung Medical Center, Seoul, KR,To whom correspondence should be addressed. E-mail:
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Balint B, Meinck HM. Pragmatic Treatment of Stiff Person Spectrum Disorders. Mov Disord Clin Pract 2018; 5:394-401. [PMID: 30363317 DOI: 10.1002/mdc3.12629] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background Stiff person spectrum disorders (SPSD) are a group of rare conditions clinically characterized by stiffness, spasms, and heightened stimulus sensitivity. They also share a spectrum of antibodies. Methods We reviewed the literature and our own experience with the aim of providing a practical approach to the treatment of SPSD. Results Because of the rarity of SPSD, there is little evidence to guide treatment decisions. The treatment of SPSD is based on the triad of symptomatic treatment, immunotherapy, and tumor treatment where appropriate. Moreover, the management involves continuous and appropriate monitoring of the symptoms of the disease, its autoimmune associations, and potential treatment side effects. Conclusions Here we delineated a pragmatic treatment approach to SPSD, based on our experience and existing literature. We also highlighted how our understanding of neuronal antibodies and their implications reflects on management considerations.
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Affiliation(s)
- Bettina Balint
- Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology Queen Square, London UK.,Neuroimmunology Group, Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford UK.,Department of Neurology University Hospital Heidelberg Germany
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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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Oaklander AL. Immunotherapy Prospects for Painful Small-fiber Sensory Neuropathies and Ganglionopathies. Neurotherapeutics 2016; 13:108-17. [PMID: 26526686 PMCID: PMC4720682 DOI: 10.1007/s13311-015-0395-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The best-known peripheral neuropathies are those affecting the large, myelinated motor and sensory fibers. These have well-established immunological causes and therapies. Far less is known about the somatic and autonomic "small fibers"; the unmyelinated C-fibers, thinly myelinated A-deltas, and postganglionic sympathetics. The small fibers sense pain and itch, innervate internal organs and tissues, and modulate the inflammatory and immune responses. Symptoms of small-fiber neuropathy include chronic pain and itch, sensory impairment, edema, and skin color, temperature, and sweating changes. Small-fiber polyneuropathy (SFPN) also causes cardiovascular, gastrointestinal, and urological symptoms, the neurologic origin of which often remains unrecognized. Routine electrodiagnostic study does not detect SFPN, so skin biopsies immunolabeled to reveal axons are recommended for diagnostic confirmation. Preliminary evidence suggests that dysimmunity causes some cases of small-fiber neuropathy. Several autoimmune diseases, including Sjögren and celiac, are associated with painful small-fiber ganglionopathy and distal axonopathy, and some patients with "idiopathic" SFPN have evidence of organ-specific dysimmunity, including serological markers. Dysimmune SFPN first came into focus in children and teenagers as they lack other risk factors, for example diabetes or toxic exposures. In them, the rudimentary evidence suggests humoral rather than cellular mechanisms and complement consumption. Preliminary evidence supports efficacy of corticosteroids and immunoglobulins in carefully selected children and adult patients. This paper reviews the evidence of immune causality and the limited data regarding immunotherapy for small-fiber-predominant ganglionitis, regional neuropathy (complex regional pain syndrome), and distal SFPN. These demonstrate the need to develop case definitions and outcome metrics to improve diagnosis, enable prospective trials, and dissect the mechanisms of small-fiber neuropathy.
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Affiliation(s)
- Anne Louise Oaklander
- Department of Neurology and Department of Pathology (Neuropathology) Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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