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Paraneoplastic Neurologic Syndromes.

Jerome J Graber

    Continuum (Minneapolis, Minn.)
    |December 12, 2023
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    Summary

    Paraneoplastic neurologic disorders are increasingly understood with new syndromes and antibodies. Early clinical diagnosis and treatment, even before confirming cancer or antibodies, can significantly improve patient outcomes.

    Area of Science:

    • Neurology
    • Immunology
    • Oncology

    Background:

    • Paraneoplastic neurologic disorders (PNDs) are a group of rare neurological conditions associated with cancer.
    • Understanding PNDs is crucial for timely diagnosis and improved patient outcomes.
    • Advances in identifying novel antibodies and associated clinical syndromes are enhancing diagnostic capabilities.

    Purpose of the Study:

    • To emphasize the clinical features of PND syndromes to guide initial diagnosis and treatment.
    • To highlight recent advancements in PND diagnosis and management.
    • To inform neurologists about the evolving landscape of PNDs.

    Main Methods:

    • Review of recent literature on PNDs, focusing on clinical presentations.
    • Summarization of newly identified antibodies and associated neurologic syndromes.

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  • Inclusion of updated diagnostic criteria and utility of biomarkers.

    • Main Results:

    • Identification of suggestive syndromes like faciobrachial dystonic seizures and pilomotor auras (anti-LGI1 encephalitis), extreme delta brush (NMDA-receptor encephalitis), and déjà vu aura (anti-GAD65 encephalitis).
    • Confirmed utility of brain PET scans and CSF markers (CEA, oligoclonal bands) for diagnosis.
    • Emerging associations between cancer immunotherapies and PNDs, and viral encephalitis with NMDA-receptor encephalitis.

    Conclusions:

    • Early clinical recognition of PNDs is vital, often preceding definitive antibody or cancer confirmation.
    • Awareness of updated diagnostic criteria and novel syndromes improves diagnostic accuracy.
    • Prompt diagnosis and treatment of PNDs are essential for better patient prognoses.