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Sequential fluctuating paraneoplastic ocular flutter–opsoclonus–myoclonus syndrome and Lambert–Eaton myasthenic syndrome in small-cell lung cancer
  1. Robert J Simister1,
  2. Karl Ng1,
  3. Bethan Lang2,
  4. Michael Beckles3,
  5. David Chao4,
  6. Dominick J H McCabe1,5
  1. 1Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, UK
  2. 2Neurosciences Group, Weatherall Institute of Molecular Medicine, Oxford, UK
  3. 3Department of Respiratory Medicine, Royal Free and University College Medical School, Royal Free Hospital, London, UK
  4. 4Department of Clinical Oncology, Royal Free and University College Medical School, Royal Free Hospital, London, UK
  5. 5Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
  1. Correspondence to Dr Dominick McCabe, Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland; dominick.mccabe{at}amnch.ie

Abstract

Paraneoplastic cerebellar degeneration may occur in association with Lambert–Eaton myasthenic syndrome (LEMS), but to our knowledge, the co-occurrence of paraneoplastic opsoclonus–myoclonus syndrome and LEMS has not been previously reported.

A 67-year-old woman presented with a complex partial seizure and evolving ocular flutter, opsoclonus, myoclonus and ‘cerebellar’ signs, all of which improved spontaneously within 6 weeks. Approximately 8 weeks after symptom onset, the patient became encephalopathic, she had a further complex partial seizure, and she became areflexic with potentiation of deep tendon reflexes. Radiological, bronchoscopic and histological investigations revealed small-cell lung cancer, and neurophysiological investigations confirmed a diagnosis of LEMS. High-titre anti-P/Q-type voltage-gated calcium-channel antibodies were identified in the serum, which increased as the signs of opsoclonus and myoclonus resolved. The encephalopathy and clinical features of LEMS responded dramatically to chemotherapy and radiotherapy.

Spontaneous improvement of paraneoplastic opsoclonus–myoclonus syndrome may occur, and this syndrome may occur in association with LEMS. Antivoltage-gated calcium-channel antibodies are not implicated in the pathogenesis of paraneoplastic opsoclonus–myoclonus syndrome.

  • Paraneoplastic opsoclonus–myoclonus syndrome
  • Lambert–Eaton myasthenic syndrome
  • antivoltage-gated calcium-channel antibodies
  • small-cell lung cancer
  • immunology
  • myoclonus
  • oncology
  • paraneoplastic syndrome

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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