Description

Paraneoplastic syndromes of the nervous system are a group of rare diseases that develop in some people who have cancer. In addition to the nervous system, paraneoplastic syndromes can also affect other organs and systems, including hormones, skin, blood and joints.

Paraneoplastic syndromes of the nervous system occur when cancer-fighting agents of the immune system also attack parts of the brain, spinal cord, peripheral nerves or muscles.

Depending on where the nervous system is affected, paraneoplastic syndromes can affect the muscle movement, coordination, sensory perception, memory, thinking skills, or even sleep.

Sometimes the injury in the nervous system can be reversed with therapy directed toward the cancer and the immune system. But sometimes paraneoplastic syndromes may result in permanent damage to the nervous system.

Treat cancer and other therapies may prevent further damage and to improve the symptoms and quality of life.

Symptoms

The symptoms of paraneoplastic syndromes of the nervous system can develop relatively quickly, often over days to weeks. Often begins even before cancer is diagnosed.

The symptoms vary depending on the injured part of the body, and can include:

  • Difficulty walking.
  • Problems with balance.
  • Loss of muscle coordination.
  • The loss of muscle tone or weakness.
  • The loss of fine motor skills, such as lifting objects.
  • Difficulty swallowing.
  • Slurred speech or stuttering.
  • The loss of memory and other thinking of deterioration.
  • Changes in vision.
  • Sleep problems.
  • Seizures.
  • Hallucinations.
  • The movements that they cannot control.

Types of paraneoplastic syndromes

Examples of paraneoplastic syndromes of the nervous system include:

  • Cerebellar degeneration, also known as cerebellar ataxia. In this syndrome, the loss of nerve cells occurs in the area of the brain called the cerebellum, which controls muscle function and balance. Symptoms may include difficulty in walking, lack of coordination in the arms and legs, difficulty maintaining posture, and dizziness. They can also include nausea, movements of the eyes that can not be controlled, double vision, difficulty speaking or difficulty swallowing.
  • Encephalitis limbic. This syndrome involves inflammation, known as inflammation, an area of the brain known as the limbic system. The limbic system controls emotions, behaviors, and certain memory functions. People with this disease may experience changes in personality or mood changes, memory loss, seizures, hallucinations, or drowsiness.
  • Encephalomyelitis. This syndrome refers to inflammation of the brain and the spinal cord. There may be a wide variety of symptoms depending on the affected area.
  • Opsoclonus-myoclonus. This syndrome occurs when the cerebellum or its connections do not work properly. Can cause rapid, irregular eye movements, and muscle jerking in the arms, legs and trunk.
  • Stiff-person syndrome. Formerly called syndrome of the man rigid, this syndrome can cause serious problems, muscle stiffness, known as the stiffness that gets worse over time. The stiffness primarily affects the spine and legs. It can also cause painful muscle spasms.
  • Myelopathy. This term refers to a syndrome that consists of the injury to the spinal cord. The symptoms depend on the level of spinal cord injury. Symptoms may include changes in bowel and bladder function, and weakness and numbness up to a certain level in the body. If the level of the lesion includes the neck, which can cause a severe disability that affects the arms and legs.
  • Lambert-Eaton myasthenic syndrome.This syndrome is caused by the interruption of the communication between the nerves and the muscles. The symptoms include weakness of the muscles in the pelvis and legs, and fatigue. It can also cause difficulty in swallowing and talking, irregular movement of the eyes, and double vision. Other symptoms may include dry mouth, and erectile dysfunction. When it occurs as a paraneoplastic syndrome, Lambert-Eaton myasthenic syndrome is typically associated with lung cancer.
  • Myasthenia gravis.Myasthenia gravis is also related with interrupted the communication between the nerves and the muscles. People with myasthenia gravis have the weakness and rapid fatigue of any of the muscles that are under voluntary control. These include the muscles of the face, the eyes, the arms and legs. The muscles involved in chewing, swallowing, speaking and breathing may be affected. When myasthenia gravis occurs as a paraneoplastic syndrome, usually associated with cancer of the thymus gland, known as thymoma.
  • Neuromyotonia, also known as Isaacs' syndrome. Neuromyotonia occurs when there is an excess in the number of nerve impulses that control muscle movement. This is known as peripheral nerve hyperexcitability. These impulses can cause muscle contractions, the muscle rippling it looks like a "bag of worms" and the stiffness that gets worse over time. It can also cause muscle cramps, slow motion, and other issues with the muscles.
  • The peripheral neuropathy. In this condition, the nerves that transmit messages from the brain or the spine to the rest of the body are damaged. These nerves are known as the peripheral nerves. When the injury involves only the sensory nerves, causing pain and changes in sensation in any part of the body.
  • Dysautonomia. Dysautonomia refers to a wide range of symptoms that result from injury to the nerves that regulate involuntary functions of the body. Known as the autonomic nervous system, these nerves control the heart rate, blood pressure, sweating, and bowel and bladder. The symptoms can include low blood pressure, irregular heartbeat, and difficulty breathing.

Lambert-Eaton myasthenic syndrome. This syndrome is caused by the interruption of the communication between the nerves and the muscles. The symptoms include weakness of the muscles in the pelvis and legs, and fatigue. It can also cause difficulty in swallowing and talking, irregular movement of the eyes, and double vision. Other symptoms may include dry mouth, and erectile dysfunction.

When it occurs as a paraneoplastic syndrome, Lambert-Eaton myasthenic syndrome is typically associated with lung cancer.

Myasthenia gravis. Myasthenia gravis is also related with interrupted the communication between the nerves and the muscles. People with myasthenia gravis have the weakness and rapid fatigue of any of the muscles that are under voluntary control. These include the muscles of the face, the eyes, the arms and legs. The muscles involved in chewing, swallowing, speaking and breathing may be affected.

When myasthenia gravis occurs as a paraneoplastic syndrome, usually associated with cancer of the thymus gland, known as thymoma.

When to see a doctor

The symptoms of paraneoplastic syndromes of the nervous system are similar to those of many diseases, including cancer, complications of cancer and some cancer treatments.

But if you have symptoms that suggest a paraneoplastic syndrome, consult your health care professional as soon as possible. The early diagnosis and the appropriate care, are important to treat the cancer and prevent further damage of the nervous system.

Causes

Paraneoplastic syndromes of the nervous system are not caused by the cancer cells directly, or by means of the spread of the cancer, known as metastasis. They are not caused by other complications, such as infections or side effects of treatment. Instead, the syndromes occur along with the cancer as a result of the activation of your immune system.

The researchers believe that the paraneoplastic syndromes of the nervous system are caused by the cancer-fighting capabilities of the immune system. In particular, antibodies, and certain white blood cells, known as T cells, are thought to be involved. Instead of targeting only the cancer cells, these immune system agents also attack healthy cells of the nervous system.

Risk factors

Any type of cancer can be associated with a paraneoplastic syndrome of the nervous system. However, it occurs more often in people with cancers of the lung, ovary, breast, testis, or the lymphatic system.

Diagnosis

To diagnose paraneoplastic syndrome of the nervous system, you may need a physical exam and blood tests. You may also need imaging tests or a lumbar puncture, also known as a lumbar puncture.

Because paraneoplastic syndromes of the nervous system are associated with cancer, you may need certain tests for detection of cancer based on her age.

Clinical examination

Your health care provider or a neurologist will perform a general physical and neurologic examination. You're questions and your health care professional to perform simple tests in the office to judge her:

  • Reflections.
  • The muscle strength.
  • The muscle tone.
  • The sense of touch.
  • The vision and hearing.
  • Coordination.
  • Balance.
  • The state of mind.
  • Memory.

Laboratory tests

Laboratory tests may include:

  • Blood tests. You can have the blood drawn from a series of tests, including tests to identify antibodies that are commonly associated with paraneoplastic syndromes of the nervous system. Other tests may help diagnose an infection, a hormone, a condition or a state in the processing of nutrients, known as a metabolic condition.
  • Spinal tap, also known as a lumbar puncture.During a lumbar puncture, a sample of cerebrospinal fluid (CSF) is taken.CSFcushions your brain and spinal cord. A neurologist or a specially trained nurse inserts a needle into the lower part of the spine to remove a small amount ofCSFfor analysis. Sometimes paraneoplastic antibodies are found inCSFbut that can't be seen in your blood. If these antibodies are found in both yourCSFand blood, provides strong evidence that a paraneoplastic syndrome is causing the symptoms.

Spinal tap, also known as a lumbar puncture. During a lumbar puncture, a sample of cerebrospinal fluid (CSF) is taken. CSF cushions your brain and spinal cord. A neurologist or a specially trained nurse inserts a needle into the lower part of the spine to remove a small amount of cerebrospinal fluid for analysis.

Sometimes paraneoplastic antibodies are found in the CSF, but that can't be seen in your blood. If these antibodies are found in both the CSF and the blood, provides strong evidence that a paraneoplastic syndrome is causing the symptoms.

Imaging tests

Imaging tests are used to find a tumor or other causes of your symptoms. One or more of the following tests may be used:

  • The computed tomography (CT) is a company that specializes in X-ray technology that produces a thin, cross-sectional images of the tissue.
  • Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create detailed cross-sectional or 3D images of the tissues of the body.
  • Positron emission tomography (PET)scan uses radioactive compounds that are injected into the bloodstream to produce a cross-section or 3D images of the body. The PET can be used to identify tumors, measure the metabolism in the tissues, show the blood flow and look for changes in the brain associated with seizures.
  • PETplusCT, a combination of PET and CT , can help you to find small cancers. Small cancers are common in people who have neurological disorders paraneoplastic.

If the tests do not find a cancerous tumor or other cause of your symptoms, you could have a tumor that is still too small to find. The tumor may be the cause of a potent response of the immune system is the maintenance is very small. Your healthcare provider will probably recommend that you have follow-up tests every 3 to 6 months until the cause is found.

Treatment

Treatment of paraneoplastic syndromes of the nervous system involves treating the cancer. Sometimes, the treatment also involves suppression of the immune response that is causing your symptoms. Your treatment depends on the type of paraneoplastic syndrome that you have. Can include the following options.

Drugs

In addition to cancer treatments, such as chemotherapy, your healthcare provider may prescribe one or more medications. These medications can help stop the immune system from damage to the nervous system:

  • Corticosteroids, such as prednisone, inhibit inflammation. These medications can have serious long-term side effects. Corticosteroids may lead to type 2 diabetes, high blood pressure, high cholesterol, and weakening of the bones, known as osteoporosis. The drug can also cause other conditions.
  • Immunosuppressants to delay the production of disease-fighting white blood cells. The side effects include an increased risk of infections. These drugs include azathioprine (Imuran, Azasan), mycophenolate (CellCept), rituximab (Rituxan, Riabni, others) and cyclophosphamide (Cytoxan). Also include methotrexate (Trexall, Xatmep, others), cyclosporine (Gengraf, Neoral, others) and tacrolimus (Astagraf XL, Envarsus XR, others). The newer drugs include eculizumab (Soliris), ravulizumab (Ultomiris) and efgartigimod (Vyvgart).

Depending on the type of paraneoplastic syndrome and symptoms, other medications may include:

  • Anti-epileptic drugs, which may help control the seizures associated with syndromes that cause electrical instability in the brain.
  • Medications to improve value-for-muscle transmission. These medications can improve symptoms of the syndromes that affect muscle function. Some medicines to improve the release of a chemical messenger that transmits a signal from the nerve cells to the muscles. Other drugs, such as pyridostigmine (Mestinon, Regonol), to prevent the decomposition of these chemical messengers.

Other medical treatments

Other treatments that can improve the symptoms include:

  • Plasmapheresis. This process is separated from the liquid part of the blood, called plasma, from the cells of your blood by using a device known as a blood cell separator. The plasma that contains the antibodies causing symptoms, it is discarded and replaced by other fluids. Their red and white blood cells along with platelets, are returned to your body.
  • Intravenous immunoglobulin (Ivig). The immunoglobulin contains healthy antibodies from blood donors. High doses of immunoglobulin to accelerate the destruction of the destruction of the antibodies in their blood.

If you have a neurological syndrome paraneoplastic, it is generally recommended not to use certain cancer medications called point of immune control of the inhibitors. These treatments activate the immune system to fight cancer. While this may help to destroy the cancer, it can also lead to a worsening of the immune attack on the nervous system.

Other therapies

Other therapies can be useful if a paraneoplastic syndrome has caused the disability:

  • The physical therapy. Specific exercises can help to recover some by the loss of muscle function.
  • Speech therapy. A speech therapist can help you learn again the necessary muscle control if you are having trouble speaking or swallowing.

Coping and support

Many people with cancer to benefit from the education and resources designed to enhance the skills of coping. If you have questions or want guidance, talk to a member of the health team. The more you know about your condition, the better you are able to participate in decisions about your care.

Support groups can put you in touch with others who have faced the same problems that we are facing. If you can not find a support group where you live, you can find one on the internet.

Preparing for your appointment

The majority of people with paraneoplastic syndromes of the nervous system, experience of symptoms prior to being diagnosed with cancer.

Therefore, it is likely to start by seeing your health care professional about your symptoms. You may be referred to a specialist in disorders of the nervous system, known as a neurologist or a specialist in cancer, known as an oncologist.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Consider the possibility of a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Write questions to ask their health professional.
  • Bring your images on a disk of your hand to your health care professional, in the appointment.

Your time with your health care professional may be limited. Prepare a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. Some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • What diagnostic tests to order? What do I need to prepare for these tests?
  • The specialists is that I have to see?
  • How soon am I likely to complete the testing and get the results?
  • What are you looking for in testing?
  • What are the conditions they are trying to rule out?

What to expect from your doctor

Your health care professional may ask the following questions:

  • Have you had any muscle weakness or lack of coordination?
  • It has had different or involuntary movements of the muscles?
  • Have you had any trouble with your vision?
  • Do you have problems chewing, swallowing or speaking?
  • Do you have any shortness of breath?
  • You have had seizures? How long have they lasted?
  • Has experienced dizziness, or nausea?
  • Do you have trouble sleeping, or have your sleep patterns changed?
  • It is difficult to perform daily tasks with your hands?
  • Have you had any numbness or tingling in the extremities?
  • Have had a significant change in mood?
  • Has been seeing or hearing things that others are not aware of?
  • Has had memory problems?
  • When did your symptoms begin?
  • The symptoms get worse?
  • Have you been diagnosed with cancer?
  • What medications do you take, including medication you take without a prescription and dietary supplements? What are the daily doses?
  • Have any close relatives have had cancer? If so, what types of cancer?
  • Have you ever smoked?
  • Do you or someone in your family have some form of autoimmune disease?
Symptoms and treatment of Paraneoplastic syndromes of the nervous system