Neurological paraneoplastic syndromes: an update

Area of Science:

• Neurology
• Immunology
• Oncology

Background:

• Paraneoplastic neurological syndromes (PNS) are rare cancer complications arising from immune cross-reactivity against neuronal antigens.
• PNS pathogenesis differs based on antibody targets: intracellular antigens (icPNS) vs. cell-surface antigens (csPNS).
• icPNS exhibit relentless progression and poor treatment response due to irreversible neuronal damage.

Purpose of the Study:

• To review recent diagnostic and therapeutic advancements in paraneoplastic neurological syndromes.
• To differentiate clinical profiles, pathogenesis, and outcomes of icPNS and csPNS.
• To emphasize the importance of optimizing immunotherapy for csPNS.

Main Methods:

• Review of current literature on paraneoplastic neurological syndromes.
• Analysis of diagnostic criteria and therapeutic strategies.
• Comparison of outcomes based on antibody targets (intracellular vs. cell-surface).

Main Results:

• The discovery of novel cell-surface antibodies has expanded the understanding of paraneoplastic autoimmunity.
• csPNS demonstrate a generally favorable response to immune therapy and better functional outcomes.
• icPNS are associated with severe neuronal loss and limited therapeutic efficacy.

Conclusions:

• The expanding spectrum of paraneoplastic autoimmunity necessitates updated diagnostic and treatment approaches.
• Optimizing immune therapies for csPNS is crucial for improving patient outcomes and preventing relapses.
• Distinguishing between icPNS and csPNS is vital for predicting prognosis and guiding treatment decisions.