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Diagnosis and Management of Paraneoplastic Neurologic Disorders

  • Neuro-oncology (GJ Lesser, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion Statement

Paraneoplastic neurologic disorders (PND) are a heterogeneous group of immune-mediated neurological disorders associated with systemic cancers. When a PND is diagnosed, prompt identification and treatment of the associated tumor is important as PND stabilization and in some cases improvement have been reported after tumor treatment. The cancer, however, may be small and difficult to detect or the onset of the PND may precede the development of the cancer by months or years. In the latter cases, patients often initially present to neurologists or internists who will need assistance from their oncology colleagues to uncover the cancer. It is therefore important to be aware of the associations of common cancers with specific PND syndromes and the significance in some PND of the presence in serum and/or cerebrospinal fluid (CSF) of specific antineuronal antibodies. Together, this information can focus the search for the tumor or support continued vigilance. Previously thought to be poorly responsive to therapies, it is now recognized that there is a subgroup of PND, mostly associated with antibodies to antigens on the neuronal cell surface that are highly treatment responsive. Treatments aimed at the PND are mostly immunosuppressive and include corticosteroids, plasma exchange and intravenous immunoglobulins (IVIg). Immunosuppressive chemotherapeutics and B-cell targeting drugs such as rituximab also may be useful. Although cancer patients tolerate these therapies, there is the risk of increased toxicity when combined with tumor-directed treatments and treatment plans should be coordinated between specialists.

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Conflict of Interest

Myrna R. Rosenfeld and Josep Dalmau declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Neurology, Hospital Clínic/IDIBAPS, Villarroel, 170, Barcelona, 08036, Spain

    Myrna R. Rosenfeld MD, PhD & Josep Dalmau MD, PhD

  2. Institució Catalana de Recerca i Estudis Avançats (ICREA) at Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Service of Neurology, Hospital Clínic, University of Barcelona, c/Villarroel, 170, Barcelona, 08036, Spain

    Josep Dalmau MD, PhD

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  1. Myrna R. Rosenfeld MD, PhD
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Correspondence to Myrna R. Rosenfeld MD, PhD.

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Rosenfeld, M.R., Dalmau, J. Diagnosis and Management of Paraneoplastic Neurologic Disorders. Curr. Treat. Options in Oncol. 14, 528–538 (2013). https://doi.org/10.1007/s11864-013-0249-1

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