Paraneoplastic movement disorders: phenomenology, diagnosis, and treatment

Chirra, Martina; Marsili, Luca; Gallerini, Simone; Keeling, Elizabeth; Marconi, Roberto; Colosimo, Carlo

doi:10.1016/j.ejim.2019.05.023

Cited by 11 publications

(26 citation statements)

References 111 publications

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“…Paraneoplastic movement disorders include, by definition, any nonmetastatic, immune-mediated, hyperkinetic, or hypokinetic conditions associated with a neoplasm [ 23 ]. The spectrum of paraneoplastic movement disorders encompasses several conditions, with acute/subacute onset, rapid evolution, and multifocal localizations [ 24 ]. PNS are conditions in which autoantibodies are produced as a reaction to antigens shared by the tumor and the nervous system [ 25 ].…”

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

“…Conversely, antibodies against neuronal surface antigens (NSA-Ab) have a direct pathogenic role but have an intermediate or rare association with cancer (“intermediate or low-risk antibodies”). NSA-Abs are directed against receptors, ion channels, or components of neural plasma membranes [ 24 ]. The difference between onconeural and NSA-Abs is important also for therapeutic implications, in fact, immunomodulatory treatment is mainly effective in the presence of NSA-Abs, while when autoantibodies are directed against intracellular antigens, it has less marked therapeutic impact (See also Section 5 ).…”

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

“…Chorea of paraneoplastic origin is often accompanied by subacute cognitive decline, progressive ataxia with or without neuropathy, behavioral changes, weight loss, dysautonomic symptoms, sleep disturbances, and bulbar symptoms [ 24 , 33 ].…”

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

“…Stiff person spectrum disorders of paraneoplastic origin are a spectrum of disorders characterized by stiffness, spasms, and hyperekplexia (e.g., excessive startle reaction to sudden stimuli as noise, movement, or touch) [ 24 ]. The classic form is characterized by muscle stiffness and painful spasms, involving trunk and proximal limb muscles [ 24 ]. In the stiff-limb syndrome (SLS), stiffness is more distal and confined to a limb [ 30 ].…”

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

“…In both PNS and n-irAEs, however, the first step is always to exclude other (more common) diagnoses, including direct neoplastic involvement (as in the case of carcinomatous meningitis, which can be difficult to demonstrate) or neuro-infectious conditions. In case of paraneoplastic conditions, the likelihood for a tumor to be the underlying cause of immune-mediated process is higher for conditions associated with onconeural antibodies (“high-risk “antibodies) compared to that of conditions associated with NSA (“intermediate-” or “low-risk” antibodies) [ 24 ]. This occurrence is relevant in the clinical practice.…”

Section: Diagnostic Algorithm and Testingmentioning

confidence: 99%

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Movement Disorders in Oncology: From Clinical Features to Biomarkers

2021

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Background: the study of movement disorders associated with oncological diseases and anticancer treatments highlights the wide range of differential diagnoses that need to be considered. In this context, the role of immune-mediated conditions is increasingly recognized and relevant, as they represent treatable disorders. Methods: we reappraise the phenomenology, pathophysiology, diagnostic testing, and treatment of movement disorders observed in the context of brain tumors, paraneoplastic conditions, and cancer immunotherapy, such as immune-checkpoint inhibitors (ICIs). Results: movement disorders secondary to brain tumors are rare and may manifest with both hyper-/hypokinetic conditions. Paraneoplastic movement disorders are caused by antineuronal antibodies targeting intracellular or neuronal surface antigens, with variable prognosis and response to treatment. ICIs promote antitumor response by the inhibition of the immune checkpoints. They are effective treatments for several malignancies, but they may cause movement disorders through an unchecked immune response. Conclusions: movement disorders due to focal neoplastic brain lesions are rare but should not be missed. Paraneoplastic movement disorders are even rarer, and their clinical-laboratory findings require focused expertise. In addition to their desired effects in cancer treatment, ICIs can induce specific neurological adverse events, sometimes manifesting with movement disorders, which often require a case-by-case, multidisciplinary, approach.

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Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

Section: Paraneoplastic Movement Disordersmentioning

confidence: 99%

Section: Diagnostic Algorithm and Testingmentioning

confidence: 99%

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Movement Disorders in Oncology: From Clinical Features to Biomarkers

2021

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Paraneoplastic movement disorder due to suspected metastatic Leiomyosarcoma of tongue: A case report

Khanal,

Paudel

et al. 2024

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Movement disorders associated with neuronal antibodies: a data-driven approach

et al. 2022

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Background Movement disorders can be associated with anti-neuronal antibodies. Methods We conducted a systematic review of cases with documented anti-neuronal antibodies in serum and/or cerebrospinal fluid published in PubMed before April 1, 2020. Only patients with at least one movement disorder were included. We used random forests for variable selection and recursive partitioning and regression trees for the creation of a data-driven decision algorithm, integrated with expert's clinical feedback. Results Three hundred and seventy-seven studies met eligibility criteria, totaling 844 patients and 13 antibodies: amphiphysin, GAD, GlyR, mGluR1, ANNA-2/Ri, Yo/PCA-1, Caspr2, NMDAR, LGI-1, CRMP5/CV2, ANNA-1/Hu, IgLON5, and DPPX. Stiffness/rigidity/spasm spectrum symptoms were more frequently associated with amphiphysin, GAD, and GlyR; ataxia with mGluR1, ANNA-2/Ri, Yo/PCA-1, Caspr2, and ANNA-1/Hu; dyskinesia with NMDAR and paroxysmal movement with LGI1; chorea/choreoathetosis with CRMP5/CV2, IgLON5, and NMDAR; myoclonus with GlyR and DPPX; tremors with ANNA2/Ri and anti-DPPX; and parkinsonism with IgLON5 and NMDAR. Data-driven classification analysis determined the following diagnostic predictions (with probability selection): psychiatric symptoms and dyskinesia predicted NMDAR (71% and 87%, respectively); stiffness/rigidity/spasm and ataxia, GAD (67% and 47%, respectively); ataxia and opsoclonus, ANNA-2/Ri (68%); chorea/choreoathetosis, CRMP5/CV2 (41%). These symptoms remained the top predictors in random forests analysis. The integration with an expert opinion analysis refined the precision of the approach. Breast and lung tumors were the most common tumors. On neuroimaging, cerebellar involvement was associated with GAD and Yo/ PCA-1; temporal involvement with Caspr2, LGI-1, ANNA-1/Hu. Conclusion Selected movement disorders are associated with specific anti-neuronal antibodies. The combination of datadriven and expert opinion approach to the diagnosis may assist early management efforts.

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Paraneoplastic movement disorders: phenomenology, diagnosis, and treatment

Cited by 11 publications

References 111 publications

Movement Disorders in Oncology: From Clinical Features to Biomarkers

Movement Disorders in Oncology: From Clinical Features to Biomarkers

Paraneoplastic movement disorder due to suspected metastatic Leiomyosarcoma of tongue: A case report

Movement disorders associated with neuronal antibodies: a data-driven approach

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