Autoimmune paraneoplastic cerebellar degeneration in ovarian carcinoma patients treated with plasmapheresis and immunoglobulin: A case report

David, Yehuda Ben; Levitan, Maurice; Sutton, David M. S.; Malkin, Mark G.; Dalmau, Josep

doi:10.1002/(sici)1097-0142(19961115)78:10<2153::aid-cncr16>3.3.co;2-z

Cited by 12 publications

(13 citation statements)

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“…Although PND of the CNS usually do not respond to immunotherapy alone, there are several case reports of patients who stabilized or improved after immunosuppression or immunomodulatory treatments, such as plasma exchange or intravenous immunoglobulins (IVIg). 58,61 The main disorders that may show response to immunotherapy or corticosteroids are opsoclonus-myoclonus and limbic encephalitis. 7,22 A recent series of selected patients (Rankin disability score between 2 and 4) with diverse PND showed that in patients without a known tumor, immunotherapy (plasma exchange and oral cyclophosphamide) at the early stages of the PND may result in improvement; patients with multifocal encephalomyelitis were not included.…”

Section: Treatment and Outcome Of Paraneoplastic Neurological Disordersmentioning

confidence: 99%

Paraneoplastic Disorders of the Central Nervous System: Update on Diagnostic Criteria and Treatment

Bataller

Dalmau

2004

Semin Neurol

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Although the discovery of antineuronal antibodies has facilitated the diagnosis of paraneoplastic neurological disorders (PNDs), the recognition and treatment of these disorders remain a challenge. Some antineuronal antibodies have a more syndrome-specific association than others, and some syndromes evoke a paraneoplastic etiology more frequently than others. Because antineuronal antibodies may occur in cancer patients without PND, their detection does not necessarily imply that a neurological disorder is paraneoplastic. This review analyzes these issues and suggests a diagnostic strategy based on criteria derived from clinical and immunological findings and the presence or absence of cancer. We provide an update on the clinical features treatment of classic PND of the central nervous system, with the proposal of a general treatment strategy. In addition, we analyze the evidence of a hypothetically effective antitumor immunity in patients with PND, which if confirmed would have implications for treatment of the cancer and PND.

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Section: Treatment and Outcome Of Paraneoplastic Neurological Disordersmentioning

confidence: 99%

Paraneoplastic Disorders of the Central Nervous System: Update on Diagnostic Criteria and Treatment

Bataller

Dalmau

2004

Semin Neurol

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“…Many authors have described different degrees of recovery after steroid therapy, IVIg therapy associated with immunosuppressant agents, or chemotherapy and/or plasmapheresis (8). Recently, treatment of paraneoplastic syndromes such as paraneoplastic central nervous system manifestations (including cerebellar ataxia), with plasmapheresis has been reported, and the results have shown poor responses to plasmapheresis (9,10). The irreversible loss of Purkinje's cells and cerebellar atrophy, might explain the ineffectiveness of treatment.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Plasmapheresis in Paraneoplastic Cerebellar Ataxia Associated With Anti‐Tr Antibody

et al. 2006

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A 53-year-old-male patient was admitted to the Hiroshima University Hospital in August 2001, with a history of progressive cerebellar ataxia, notable by standing and gait disturbances. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed no signs of ischemic damage. Two weeks later, left axillary lymphadenopathy developed. The pathological finding was Hodgkin's disease (HD; a classical malignant lymphoma in an early stage). Serum antibodies against Purkinje's cells (anti-Tr antibody) were detected by immunohistochemical study. Thus, we diagnosed this as paraneoplastic cerebellar degeneration (PCD) associated HD. We immediately carried out chemotherapy (ABVD therapy), radiotherapy with 20-30 Gy, steroid pulse and intravenous immunoglobulin (IVIg) without neurologic improvement. The patient was subsequently treated by double filtration plasmapheresis (DFPP), leading to a marked improvement of standing and gait disturbances and to a reduction of autoantibodies, which became undetectable. We conclude that DFPP might be useful in treating patients with cerebellar ataxia, and should be considered as a therapeutic choice for it.

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“…Although paraneoplastic neurologic disorders of the CNS usually do not respond to immunotherapy alone, there are several case reports of patients who stabilized or improved after immunosuppression or immunomodulatory treatments, such as plasma exchange or IVIg. 99,100 The main disorders that may show response to immunotherapy or corticosteroids are opsoclonus-myoclonus and limbic encephalitis. 69,79 A series of selected patients (Rankin disability score between 2 to 4) with diverse paraneoplastic neurologic disorders showed that in patients without a known tumor, immunotherapy (plasma exchange and oral cyclophosphamide) at the early stages of the paraneoplastic neurologic disorder may result in improvement; patients with multifocal encephalomyelitis were not included.…”

Section: Considerations Related To Treatment and Outcome Of Paraneoplmentioning

confidence: 99%

Update on Paraneoplastic and Autoimmune Disorders of the Central Nervous System

Rosenfeld

Dalmau

2010

Semin Neurol

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Although the discovery of antineuronal antibodies has facilitated the diagnosis of paraneoplastic neurologic disorders, the recognition and treatment of these disorders remain a challenge. Some antibodies are more syndrome-specific than others, and some syndromes suggest a paraneoplastic etiology more frequently than others. Because some antineuronal antibodies may occur in cancer patients without paraneoplastic neurologic disorders, their detection does not necessarily imply that a neurologic disorder is paraneoplastic. Moreover, there is an emerging group of encephalitides that appear to be mediated by antibodies against cell surface or synaptic proteins, may occur with or without tumor association, and are responsive to treatment. This review analyzes the immune responses associated with paraneoplastic and nonparaneoplastic disorders of the central nervous system, and the main clinical features and response to treatment.

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Autoimmune paraneoplastic cerebellar degeneration in ovarian carcinoma patients treated with plasmapheresis and immunoglobulin: A case report

Abstract: Although this is only a single case report, the authors believe that the dire prognosis of PCD and the lack of effective therapy warrant a trial of this combined treatment early in the course of the disease. Confirmatory evidence of the efficacy of such an approach would be welcomed.

Cited by 12 publications

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Paraneoplastic Disorders of the Central Nervous System: Update on Diagnostic Criteria and Treatment

Paraneoplastic Disorders of the Central Nervous System: Update on Diagnostic Criteria and Treatment

A Case Report of Plasmapheresis in Paraneoplastic Cerebellar Ataxia Associated With Anti‐Tr Antibody

Update on Paraneoplastic and Autoimmune Disorders of the Central Nervous System

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