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Simard C, Vogrig A, Joubert B, Muñiz-Castrillo S, Picard G, Rogemond V, Ducray F, Berzero G, Psimaras D, Antoine JC, Desestret V, Honnorat J. Clinical spectrum and diagnostic pitfalls of neurologic syndromes with Ri antibodies. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e699. [PMID: 32170042 PMCID: PMC7136048 DOI: 10.1212/nxi.0000000000000699] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/03/2020] [Indexed: 11/15/2022]
Abstract
Objective To describe the main syndrome and clinical course in a large cohort of patients with anti–Ri-associated paraneoplastic neurologic syndrome (Ri-PNS). Methods Twenty-year retrospective nationwide study and systematic review of the literature. Results Thirty-six patients with complete clinical information were identified (median age 66 years, range: 47–87 years). In this French cohort, the majority were women (78%). At onset, 4 main patterns were observed: cerebellar syndrome (39%), isolated tremor (24%), oculomotor disturbances (17%), and other symptoms (19%). Course was multistep for 78% of cases. At the time the disease reached the plateau phase (median 12 weeks, range: 1–64 weeks; 28% >3 months), 24 (67%) showed an overt cerebellar syndrome, which was isolated in 3 patients, and was most frequently (21/24 cases) part of a multisystem neurologic disease. Patients manifested a variety of movement disorders, including myoclonus (33%), dystonia (17%), either cervical or oromandibular, and parkinsonism (17%). Most patients had cancer (92%), mainly breast cancer (n = 22). Misdiagnoses concerned 22% of patients (n = 8) and included atypical parkinsonism (n = 2), MS (n = 2), Bickerstaff encephalitis (n = 1), hyperekplexia (n = 1), vestibular neuritis (n = 1), and functional neurologic disorder (n = 1). Survival at 12 months was 73% (95% CI [0.54–0.85]), at 24 months 62% (95% CI [0.41–0.78]), and at 36 months 47% (95% CI [0.25–0.65]). There was no major clinical difference between cases retrieved from the systematic review of the literature (n = 55) and the French cohort. Conclusions Ri-PNS is a multisystem neurologic syndrome with prominent cerebellum/brainstem involvement. Opsoclonus-myoclonus is less common than expected, and the disorder can mimic neurodegenerative diseases.
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Affiliation(s)
- Claire Simard
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Alberto Vogrig
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Bastien Joubert
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Sergio Muñiz-Castrillo
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Géraldine Picard
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Véronique Rogemond
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - François Ducray
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Giulia Berzero
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Dimitri Psimaras
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Jean-Christophe Antoine
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Virginie Desestret
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France
| | - Jérôme Honnorat
- From the Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., J.-C.A., V.D., J.H.), Hôpital Neurologique, Hospices Civils de Lyon; SynatAc Team (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310; Université Claude Bernard Lyon 1 (C.S., A.V., B.J., S.M.-C., G.P., V.R., F.D., V.D., J.H.), Université de Lyon; AP-HP (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2-Mazarin et Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975; Inserm U 975 (G.B., D.P.), CNRS, UMR 7225; Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes (G.B., D.P.), Groupe Hospitalier Pitié-Salpêtrière, Paris; and Service de Neurologie (J.-C.A.), CHU de Saint-Etienne, Saint-Etienne, France.
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Vogrig A, Gigli GL, Segatti S, Corazza E, Marini A, Bernardini A, Valent F, Fabris M, Curcio F, Brigo F, Iacono D, Passadore P, Rana M, Honnorat J, Valente M. Epidemiology of paraneoplastic neurological syndromes: a population-based study. J Neurol 2019; 267:26-35. [PMID: 31552550 DOI: 10.1007/s00415-019-09544-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epidemiology of paraneoplastic neurological syndromes (PNS) remains to be defined. We present here the first population-based incidence study and report the clinical spectrum and antibody profile of PNS in a large area in Northeastern Italy. METHODS We performed a 9-year (2009-2017) population-based epidemiological study of PNS in the provinces of Udine, Pordenone and Gorizia, in the Friuli-Venezia Giulia region (983,190 people as of January 1, 2017). PNS diagnosis and subgroups were defined by the 2004 diagnostic criteria. Age- and sex-adjusted incidence rates were calculated. RESULTS We identified 89 patients with a diagnosis of definite PNS. Median age was 68 years (range 26-90), 52% were female. The incidence of PNS was 0.89/100,000 person-years. PNS incidence rates increased over time from 0.62/100,000 person-years (2009-2011), 0.81/100,000 person-years (2012-2014) to 1.22/100,000 person-years (2015-2017). The prevalence of PNS was 4.37 per 100,000. Most common PNS were limbic encephalitis (31%), cerebellar degeneration (28%) and encephalomyelitis (20%). Among antibody (Ab)-positive cases, most frequent specificities included: Yo (30%), Hu (26%), and Ma2 (22%), while the most frequent associated tumors were lung (17%) and breast cancer (16%), followed by lymphoma (12%). PNS developed in 1 in every 334 cancers in our region. Statistically significant associations were observed between cancer type and Ab-specificity (P < 0.001), and between neurological syndrome and Ab-specificity (P < 0.001). CONCLUSIONS This first population-based study found an incidence of PNS that approximates 1/100,000 person-years and a prevalence of 4/100,000. Moreover, the incidence of PNS is increasing over time, probably due to increased awareness and improved detection techniques.
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Affiliation(s)
- Alberto Vogrig
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy. .,French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France. .,SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France. .,University Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.,Department of Medicine (DAME), University of Udine Medical School, Udine, Italy.,Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy
| | - Samantha Segatti
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Elisa Corazza
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Alessandro Marini
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Andrea Bernardini
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Martina Fabris
- Department of Laboratory Medicine, Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Curcio
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy.,Department of Laboratory Medicine, Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Hospital Franz Tappeiner, Merano, Italy
| | - Donatella Iacono
- Department of Oncology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Michele Rana
- Neurology Unit, Hospital of Gorizia, Gorizia, Italy
| | - Jérôme Honnorat
- French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France.,University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Mariarosaria Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33010, Udine, Italy.,Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
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