Paraneoplastic movement disorders

Abstract

Paraneoplastic movement disorders are rare autoimmune nonmetastatic complications of cancer. Common paraneoplastic movement disorders include cerebellar syndrome, opsoclonus myoclonus, basal ganglia disorders, stiff person syndrome, and neuromyotonia. Syndromes usually present before cancer diagnosis and are commonly associated with one or more serum antibodies. Increasing numbers of antibodies have been identified (Hu, Yo, Ri, CV2, amphiphysin, Ma, Ta, Tr, NMDA, mGluR1, PCA2, ANNA-3, VGCCA). Antibodies are highly correlated with the likelihood of an underlying cancer and are closely associated with certain tumors. Clinical clues to paraneoplastic aetiology include speed of onset, severity, speed of progression, resistance to treatment, and more widespread neurological signs than one would expect from nonparaneoplastic aetiologies. Cancer should be sought in those with classical presentations and those with possible presentations who have paraneoplastic antibodies. If no tumor is found on initial investigation, interval screening is advisable. The most common associated cancers found are small cell lung cancer, breast, gynaecological, testicular, lymphoma, and thymoma. Early identification and treatment sometimes leads to neurological improvement and may improve cancer prognosis. Prognosis is dependent on the tumor type and its likely response to treatment.

Neurological disorders associated with glutamic acid decarboxylase antibodies: a Brazilian series

“…Clinically, stiff-person syndrome presents as neurological paraneoplastic syndromes in about 5% of cases 1,20,21 . In such cases, paraneoplastic stiff-person syndrome is usually associated with amphiphysin or anti-gephyrin antibodies 20 .…”

“…In such cases, paraneoplastic stiff-person syndrome is usually associated with amphiphysin or anti-gephyrin antibodies 20 . While a few cases of paraneoplastic SPS have been described in anti-GAD-antibody-positive patients with thymoma and other solid tumors, a finding of anti-GAD antibodies in patients with other classical paraneoplastic neurological syndromes is rare 10,20 .…”

“…In such cases, paraneoplastic stiff-person syndrome is usually associated with amphiphysin or anti-gephyrin antibodies 20 . While a few cases of paraneoplastic SPS have been described in anti-GAD-antibody-positive patients with thymoma and other solid tumors, a finding of anti-GAD antibodies in patients with other classical paraneoplastic neurological syndromes is rare 10,20 . Progressive encephalomyelitis is a rare form of SPS characterized by brainstem, extrapyramidal and spinal cord dysfunction with acute onset of painful rigidity and muscle spasm in association with nystagmus, opsoclonus, ophthalmoparesis, deafness, dysarthria, dysphagia and autonomic dysfunction 21,22 .…”

Paraneoplastic ataxia and dystonia secondary to a malignant fibrous histiocytoma

“…This led to an extensive search for a primary causative tumour, which for 3 years was negative. It was not until a mass appeared in the gluteal region that the tumour was identified and treated and the patient's condition stabilised 3. There are now internationally accepted diagnostic criteria for paraneoplastic syndromes which have been summarised in figure 1 4.…”

Neues bei paraneoplastischen Syndromen in der Neurologie

“…Bei Nachweis von CV2/CRMP5-AK zeigt sich in bis zu 70 % der Fälle initial eine meist asymmetrische oder einseitige Chorea, im Verlauf entwickelt sich bei 90 % der Patienten jedoch eine Beteiligung weiterer Systeme [ 50 ] . Auch subakut progrediente progressive supranukleäre Paralyse-ähnli-che Erkrankungsbilder sind paraneoplastisch bei Lymphomen beschrieben (Anti-Ma/Ma2 [ 51 ] ). Während etwa jeder zehnte Tumorpatient über Visusstörungen klagt, ist die paraneoplastische Retinopathie relativ selten.…”