Paraneoplastic neurologic syndrome: A practical approach
| Autor: | Sudheeran Kannoth |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Oncology
medicine.medical_specialty medicine.medical_treatment Malignancy lcsh:RC346-429 Metastasis Internal medicine Review: Management Updates (Reviews on advances in treatment) medicine paraneoplastic neurological syndrome lcsh:Neurology. Diseases of the nervous system biology business.industry Cancer Immunotherapy medicine.disease onconeural antibodies paraneoplastic antibodies Potassium channel complex Supportive psychotherapy Immunology biology.protein Rituximab Neurology (clinical) Antibody business medicine.drug |
| Zdroj: | Annals of Indian Academy of Neurology, Vol 15, Iss 1, Pp 6-12 (2012) Annals of Indian Academy of Neurology |
| ISSN: | 1998-3549 0972-2327 |
| Popis: | Paraneoplastic neurological syndromes (PNS) are rare disorders associated with cancer, not caused by direct invasion, metastasis or consequences of treatment. They are usually autoimmune in nature. Often, PNS precedes the manifestations of cancer. Onconeural antibodies are important in the diagnosis and management of these disorders. These antibodies are specific for the malignancy rather than for a particular neurological syndrome. Often, there are different antibodies associated with the same syndrome. Multiple antibodies are also known to coexist in a given patient with malignancy. While investigating a patient for suspected PNS, the entire gamut of onconeural antibodies should be investigated so as not to miss the diagnosis. In 30-40% of the cases, PNS can occur without antibodies. Investigations for identifying the underlying cancer can be directed by the antibody panel. If conventional screening for cancer is negative, a positron emission scanning/computed tomography scan can be useful. Patients need follow-up surveillance for cancer if not detected in the first instance. Cancer detection and treatment, immunotherapy and supportive care are important components of treatment of PNS. Immunotherapy is very effective in PNS associated with cell membrane-associated antibodies like voltage-gated potassium channel complex, NMDA receptor antibodies and voltage-gated calcium channel antibodies. Immunotherapy includes steroids, IVIgG, plasmaphereis, cytotoxic medications and rituximab. Supportive therapy includes symptomatic treatment with antiepileptic and analgesic medications, physiotherapy, speech therapy and occupational therapy. PNS can mimic any neurologic syndrome. A high index of clinical suspicion is important for early diagnosis and prompt management and better outcome. |
| Databáze: | OpenAIRE |
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