Paraneoplastic opsoclonus–myoclonus syndrome as a rare presentation of breast cancer

Martins, Lisandra; Galvão, Diogo; Silva, Anaísa; Vieira, Bárbara; Reis, Óscar; Vitorino, Rita; Pires, Paula

doi:10.1093/jscr/rjy365

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…OMS has been described in melanoma cases rarely [ 5 , 6 ]. ANNA-2 is mostly associated with breast cancer [ 7 , 8 ], and recurrent paraneoplastic encephalitis has been reported in breast cancer [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

New-Onset Refractory Status Epilepticus (NORSE) as a Recurrence of Anti-Neuronal Nuclear Antibody 2 (ANNA-2) Encephalitis After Immune Checkpoint Inhibition Therapy

Pitter

Mejico

Latorre

et al. 2021

Cureus

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Paraneoplastic encephalitis from anti-neuronal nuclear antibody 2 (ANNA-2), usually associated with breast cancer, can cause seizures. We report a case of recurrent paraneoplastic encephalitis due to ANNA-2 presenting with new-onset refractory status epilepticus (NORSE) one month after receiving checkpoint inhibitors therapy.A 69-year-old female was diagnosed with opsoclonus myoclonus syndrome (OMS) secondary to ANNA-2, which led to a diagnosis of breast cancer. OMS improved with surgical resection and intravenous immunoglobulin (IVIG). Three years later, she was diagnosed with metastatic cancer to the liver and spine. She underwent immune checkpoint inhibitor therapy. One month later, she was admitted with NORSE. Opsoclonus was seen at the physical exam. Brain MRI and infectious work-up were unremarkable. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with lymphocytic predominance. She was treated with corticosteroids and immunoglobulins, and she had symptomatic improvement. ANNA-2 test was positive in a lower titration than three years earlier.Opsoclonus in a patient with NORSE can be the hint of ANNA-2 positivity. Immune checkpoint inhibitor therapy should be carefully reconsidered in patients with a history of paraneoplastic encephalitis for ANNA-2 as it could precipitate NORSE.

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Section: Discussionmentioning

confidence: 99%

New-Onset Refractory Status Epilepticus (NORSE) as a Recurrence of Anti-Neuronal Nuclear Antibody 2 (ANNA-2) Encephalitis After Immune Checkpoint Inhibition Therapy

Pitter

Mejico

Latorre

et al. 2021

Cureus

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“…The symptoms of cerebellar dysfunction in the case presented include opsoclonus, myoclonus, and ataxia, which has led to its colloquial name, "dancing eyes, dancing feet syndrome". Opsoclonus is characterized by rapid, dysrhythmic, and uncoordinated eye movements [3,7]. The neuronal damage is induced by antibodies typically associated with the primary pathology [4].…”

Section: Introductionmentioning

confidence: 99%

“…In adult cases, opsoclonus-myoclonus can be considered an autoimmune phenomenon with idiopathic or neoplastic origins, often accompanying breast carcinoma or small-cell lung carcinoma [4,5]. There appears to be a genetic predisposition to autoimmunity in these patients, as frequent autoimmune disorders are observed in families of those with Paraneoplastic Opsoclonus-Myoclonus Ataxia Syndrome (POMA), and there is a correlation with the Human Leucocyte Antigen (HLA) class II locus DR B1*01 [7]. The pathogenesis is thought to be immune-mediated based on the paraneoplastic nature of the syndrome and its symptomatic response to immunosuppressive therapy.…”

Section: Introductionmentioning

confidence: 99%

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Paraneoplastic opsoclonus-myoclonus syndrome as a rare presentation of parotid adenocarcinoma

Yılmaz

2024

J Surg Med

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Paraneoplastic Opsoclonus-Myoclonus Ataxia Syndrome (POMA) is a rare neurological condition that affects approximately 1 in 10,000,000 people annually. This syndrome is poorly understood and can lead to long-term cognitive, behavioral, and motor complications. Opsoclonus is characterized by involuntary, rapid, repetitive, multi-vectorial oscillations of the eyes occurring in all directions of gaze. It is accompanied by diffuse or focal body myoclonus and may or may not include ataxia and other cerebellar signs. POMA is typically a paraneoplastic syndrome associated with neuroblastoma in childhood and breast carcinoma or small-cell lung carcinoma in adults. Additionally, viral or toxic agents are known to play a role in its etiology, and the immune system is involved in the pathogenesis. We report a case of a 41-year-old man with anti-Ri antibody opsoclonus-myoclonus syndrome and parotid adenocarcinoma involvement. After diagnosing opsoclonus-myoclonus syndrome, the patient underwent multimodal immunotherapy treatment, resulting in partial remission of the neurological symptoms.

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“…Small-cell carcinoma of the lung is the most commonly reported malignancy associated with OMS in adults, but cases related to breast cancer, melanoma, and gynecologic and urogenital cancers have been reported [3,[5][6][7][8][9][10][11]. Importantly, the onset of OMS generally precedes other clinical manifestations related to cancer, offering the opportunity for an early diagnosis [8].…”

Section: Introductionmentioning

confidence: 99%

Paraneoplastic Opsoclonus-Myoclonus Syndrome as a Rare Presentation of Small-Cell Lung Cancer

Moreira¹,

Vilas-Boas²,

Neves³

2022

Cureus

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Opsoclonus-myoclonus syndrome (OMS), also known as Kinsbourne syndrome or dancing eyes syndrome, is an extremely rare neurological condition that comprises a heterogenous constellation of symptoms including opsoclonus along with diffuse or focal body myoclonus. It is usually referred to as a paraneoplastic entity, but it may also be associated to an infectious, metabolic, or idiopathic cause. Small-cell carcinoma of the lung is the most commonly reported malignancy associated with OMS. The authors describe a case of a 69-year-old male that presented with ataxic gait, phono-and photophobia, vertigo, dizziness, lethargy, nausea, and vomiting. During examination, rapid, multidirectional eye movements; slight dysarthria; and facial myoclonus were noted. He was admitted to the hospital, and after a thorough study, a diagnosis of OMS was established. Intravenous corticosteroids were started, alongside physiotherapy, and a slight improvement of his symptoms was noted. Imaging revealed a suspicious lesion in the left lung, along with lymphadenopathies and bone metastases. Histology confirmed the diagnosis of stage IV small-cell lung cancer (SCLC). Chemotherapy (ChT) with carboplatin and etoposide was started, and a gradual improvement of his neurological complaints was noted. After six cycles, the disease progressed, and secondline ChT with topotecan was started. After two cycles, the patient experienced significant clinical deterioration and eventually died. In conclusion, OMS is a poorly understood condition with uncertain neurological prognosis. The treatment of the primary neoplasm may improve neurological symptoms. The recognition of paraneoplastic syndromes is of utmost importance since early diagnosis of a malignancy relates to better outcomes.

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Paraneoplastic opsoclonus–myoclonus syndrome as a rare presentation of breast cancer

Cited by 6 publications

References 9 publications

New-Onset Refractory Status Epilepticus (NORSE) as a Recurrence of Anti-Neuronal Nuclear Antibody 2 (ANNA-2) Encephalitis After Immune Checkpoint Inhibition Therapy

New-Onset Refractory Status Epilepticus (NORSE) as a Recurrence of Anti-Neuronal Nuclear Antibody 2 (ANNA-2) Encephalitis After Immune Checkpoint Inhibition Therapy

Paraneoplastic opsoclonus-myoclonus syndrome as a rare presentation of parotid adenocarcinoma

Paraneoplastic Opsoclonus-Myoclonus Syndrome as a Rare Presentation of Small-Cell Lung Cancer

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