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Review
. 2012 Dec;25(6):795-801.
doi: 10.1097/WCO.0b013e328359da15.

Paraneoplastic Neurological Syndromes

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Free PMC article
Review

Paraneoplastic Neurological Syndromes

Francesc Graus et al. Curr Opin Neurol. .
Free PMC article

Abstract

Purpose of review: This review describes relevant advances in paraneoplastic neurological syndromes (PNS) with emphasis on particular syndromes and the impact of antibodies against surface antigens in their management.

Recent findings: PNS may present with symptoms that do not raise the suspicion of a paraneoplastic origin. The best example is anti-N-methyl-D-aspartate receptor encephalitis that in adult women frequently associates with ovarian teratoma. An electroencephalogram pattern described as 'extreme delta brush' was recently identified in 30% of patients with this disorder. Isolated myelopathy may have a paraneoplastic origin associated with amphiphysin or CV2 (CRMP5) antibodies. Jaw dystonia and laryngospasm can be the predominant symptom of the brainstem encephalitis associated with Ri antibodies. γ-Aminobutyric acid (GABA)(B) receptor antibodies are the most common antibodies found in patients with limbic encephalitis and small cell lung cancer, and contactin-associated protein 2 antibodies in patients with Morvan's syndrome and thymoma. Lastly, a recent study identified delta/notch-like epidermal growth factor-related receptor (DNER) as the target antigen of Tr antibodies, a marker of cerebellar ataxia and Hodgkin's lymphoma.

Summary: The number of antibodies relevant to PNS is now expanded to those against surface antigens. These antibodies do not confirm the paraneoplastic origin of the syndrome but predict a better response to immunotherapy.

Conflict of interest statement

Conflicts of interest

Dr Graus declares no conflicts of interest. Dr Dalmau has received a research grant from Euroimmun, and receives royalties from patents for the use of Ma2 and NMDAR as autoantibody test.

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