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Goudsmit A, Brandao M, Oullai A, Engelman D, Ghorra N, Daif T, Buelens T, Meert AP. Optic neuritis in lung adenocarcinoma: A challenging diagnosis. Respir Med Res 2022; 82:100966. [DOI: 10.1016/j.resmer.2022.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
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Gong S, Han Y, He E, Liu M, Fu X, Deng F. Coexistence of anti-SOX1 and anti-GABAB receptor antibodies with paraneoplastic limbic encephalitis presenting with seizures and memory impairment in small cell lung cancer: A case report. Front Immunol 2022; 13:955170. [PMID: 35967304 PMCID: PMC9365934 DOI: 10.3389/fimmu.2022.955170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose Paraneoplastic neurological syndromes associated with autoantibodies are rare diseases that cause abnormal manifestations of the nervous system. Early diagnosis of paraneoplastic neurological syndromes paves the way for prompt and efficient therapy. Case report we reported a 56-year-old man presenting with seizures and rapidly progressive cognitive impairment diagnosed as paraneoplastic limbic encephalitis (PLE) with anti-SRY-like high-mobility group box-1 (SOX-1) and anti-γ-aminobutyric acid B (GABAB) receptor antibodies and finally confirmed by biopsy as small cell lung cancer (SCLC). At the first admission, brain magnetic resonance imaging (MRI) showed no abnormal signal in bilateral hippocampal regions and no abnormal enhancement of enhanced scan. The serum anti-GABAB receptor antibody was 1:100 and was diagnosed as autoimmune encephalitis (AE). The computed tomography (CT) scans of the chest showed no obvious tumor signs for the first time. Although positron emission tomography-computed tomography (PET-CT) revealed hypermetabolism in the para mid-esophageal, the patient and his family declined to undertake a biopsy. The patient improved after receiving immunoglobulin, antiepileptic therapy, and intravenous methylprednisolone (IVMP) pulse treatment. However, after 4 months, the symptoms reappeared. Brain MRI revealed abnormal signals in the hippocampal regions. Reexamination of the cerebral fluid revealed anti-GABAB receptor and anti-SOX-1 antibodies, which contributed to the diagnosis of PLE. SCLC was found in a para mid-esophageal pathological biopsy. Antiepileptic medications and immunoglobulin were used to treat the patient, and the symptoms were under control. Conclusion Our findings increase the awareness that patients with limbic encephalitis with cognitive dysfunction and epileptic seizures should be enhanced to detect latent malignancy. Our case also highlights the importance of anti-SOX1 antibodies in the detection of underlying neoplasm, particularly SCLC. Our findings raise awareness of the cognitive impairment seen by patients with limbic encephalitis.
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Ernani V, Du L, Ross HJ, Yi JE, Wampfler JA, Schild SE, Xie H, Swanson KL, Tazelaar HD, Yang P. Gastroesophageal reflux disease and paraneoplastic neurological syndrome associated with long-term survival in limited stage small-cell lung cancer. Thorac Cancer 2022; 13:925-933. [PMID: 35194958 PMCID: PMC8977164 DOI: 10.1111/1759-7714.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Patients with small‐cell lung cancer (SCLC) have a very poor prognosis. However, a subset of SCLC achieves long‐term survival. The objective of this study was to investigate factors and pattern of long‐term survival in patients with limited‐stage small cell lung cancer (LS‐SCLC) who achieved a complete response (CR) after chemoradiotherapy. Patient and Methods This was a single‐center retrospective study. The analysis of hazard ratio (HR) and 95% confidence interval (CI) was performed using Cox proportional hazards model. For pattern analysis, the date of recurrence was used as the endpoint. The nominal categorical variables were analyzed by the χ2 test. Survival was estimated using the Kaplan–Meier model, and the results were reported as the median and interquartile range. Results We identified 162 patients, median age was 64.7 (56.2–70.2) years, and 94 (58%) were females. Eighty‐one patients (50%) had recurrence during follow‐up. Gastroesophageal reflux disease (GERD) (HR, 0.65; 95% CI, 0.45–0.93; p = 0.016) and neurological paraneoplastic syndrome (PNS) (HR, 0.46; 95% CI, 0.29–0.72; p < 0.001) were independent factors associated with improved overall survival (OS). Patients with GERD had prolonged recurrence free survival (RFS) compared to patients without GERD (median, 29.1 months vs. 13.9 months, p < 0.001), whereas patients with neurological PNS had a reduced recurrence rate compared to those patients without neurological PNS (No. [%], 8 [20.5] vs. 73 [59.3], p < 0.001). Conclusions Patients with LS‐SCLC achieving a CR after chemoradiotherapy, GERD, and neurological PNS were associated with improved OS. GERD and neurological PNS were associated with longer RFS and lower recurrence rate, respectively.
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Affiliation(s)
- Vinicius Ernani
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Lin Du
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China.,Department of Department of Quantitative Health Science, Mayo Clinic, Rochester, Minnesota, USA.,Graduate School, Tianjin Medical University, Tianjin, China
| | - Helen J Ross
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA.,Hematology/Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Joanne E Yi
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason A Wampfler
- Department of Department of Quantitative Health Science, Mayo Clinic, Scottsdale, Arizona, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Hao Xie
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Karen L Swanson
- Department of Pulmonary Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Henry D Tazelaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Arizona, USA
| | - Ping Yang
- Department of Department of Quantitative Health Science, Mayo Clinic, Rochester, Minnesota, USA
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Iwasa K, Uemasu K, Hirayama Y, Kitaoka A, Yasuda Y, Iwashima D, Tada S, Takahashi KI. Anti-SOX1 antibody-positive paraneoplastic neurological syndrome presenting with paraneoplastic encephalomyelitis caused by small-cell lung cancer: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Postoperative Delirium in Patients After Brain Tumor Surgery. World Neurosurg 2021; 155:e472-e479. [PMID: 34455093 DOI: 10.1016/j.wneu.2021.08.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postoperative delirium is a common surgical complication that can be associated with poorer outcome. Many patients with brain tumors experience delirium after surgery. We hypothesize that patients who experience delirium after resection of a brain tumor will have worse outcomes post surgery in terms of mortality, disposition, and length of stay compared with those without postoperative delirium. We also examine differences between nurse and physician diagnoses of delirium. METHODS Data from patients undergoing brain tumor resection at University of Missouri Hospital were retrospectively collected. Delirium was defined using Diagnostic and Statistical Manual-5 criteria. Patients with delirium were compared with patients without delirium using chi-squared test, Cohen Kappa value, and binomial proportion analysis at 95% confidence intervals or P < 0.05. RESULTS Of 500 patients having brain tumor resections, 93 (18.6%) were diagnosed with postoperative delirium. Patients with delirium had higher 30-day mortality (9.78% vs. 1.48%; P < 0.0001), required restraints more often (42.39% vs. 5.91%, P < 0.0001), had longer hospital length of stay (14.3 vs. 6.3 days; P < 0.0001), and increased skilled nursing facility disposition (57.3% vs. 26.11%; P < 0.0001) than patients without delirium. Diagnosis of delirium between nursing staff and clinicians moderately correlated (Kappa 0.5677 ± 0.0536). CONCLUSIONS Delirium, a common postoperative complication after brain tumor surgery, is associated with longer length of stay, increased disposition to skilled nursing facility, and increased 30-day mortality. These findings reinforce the importance of early recognition, diagnosis, and treatment of postoperative delirium in brain tumor resection patients.
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Paraneoplastic myelitis associated with durvalumab treatment for extensive-stage small cell lung cancer. Invest New Drugs 2021; 40:151-156. [PMID: 34287773 PMCID: PMC8763935 DOI: 10.1007/s10637-021-01154-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/14/2021] [Indexed: 11/01/2022]
Abstract
Paraneoplastic neurologic syndromes(PNSs) caused by immune checkpoint inhibitors(ICIs) is rare and requires clinicians to differentiate between disease progression and immune-related adverse effects(irAEs). We hereby report the case of immune-related myelitis accompanied by positive paraneoplastic autoantibodies following durvalumab treatment for extensive-stage small cell lung cancer (ES-SCLC). A 70-year-old Chinese woman with ES-SCLC was administered durvalumab with etoposid-platinum(EP) as first-line treatment. Four cycles after treatment with EP plus ICI, she developed immune-related myelitis with positive paraneoplastic autoantibodies (CV2, SOX1, ZIC4). Spinal MRI showed diffuse abnormal signal shadow in the cervicothoracic spinal cord. She was discontinued for chemotherapy, and treated with high-dose steroids, intravenous immunoglobulin and plasmapheresis, maintenance therapy with steroids resulted in a favorable neurologic outcome. This is the first report of durvalumab-related PNSs. We supposed that the development of paraneoplastic myelitis was causally related to immune activation by durvalumab. Prompt diagnosis and therapeutic intervention are essential for the effective treatment of paraneoplastic myelitis.
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A Case of Paraneoplastic Myoclonus Attributed to Non-Small Cell Lung Cancer. Tremor Other Hyperkinet Mov (N Y) 2020; 10:7. [PMID: 32775021 PMCID: PMC7394212 DOI: 10.5334/tohm.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: It is well known that myoclonus can be a paraneoplastic manifestation of underlying malignancy. Case Report: A 78-year-old male diagnosed with papillary variant non-small cell lung cancer (NSCLC) presented with tremulousness that rapidly evolved into severe, diffuse myoclonus with prominent palatal involvement requiring intubation. The generalized myoclonus resolved with on levetiracetam, chemotherapy and immune modulation. While low titer positive P/Q type calcium channel autoantibodies were detected, it’s etiologic relevance is unclear. Discussion: This case highlights a rare neurologic paraneoplastic presentation of papillary NSCLC. It also illustrates the importance of monitoring airway safety when myoclonus is generalized. Highlights: A new, rare paraneoplastic presentation of papillary variant non-small cell lung adenocarcinoma is described. The patient presented with severe diffuse myoclonus with prominent palatal involvement without encephalitis that responded to a combination of chemotherapy, immune modulation, and levetiracetam. No clear causal antibody was found.
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Coureau M, Meert AP, Berghmans T, Grigoriu B. Efficacy and Toxicity of Immune -Checkpoint Inhibitors in Patients With Preexisting Autoimmune Disorders. Front Med (Lausanne) 2020; 7:137. [PMID: 32457912 PMCID: PMC7220995 DOI: 10.3389/fmed.2020.00137] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Immunotherapy is an important armamentarium for cancer treatment nowadays. Apart from their significant effectiveness in controlling disease they also generate potential severe immune related adverse effects. Preexistence of immune related conditions may eventually predispose to the development of more severe complication and extreme caution have been taken in treating these patients. We performed a literature review searching for case reports and case series in order to offer evidence-based data for clinical management of these patients. Preexisting serological-only immune abnormalities or presence of a predisposing genetic background does not seem to confer significant risk but existing data is scarce. Most patients with preexistent autoimmune diseases can probably treated with checkpoint inhibitors as they seem to have at least the same response rate as the general cancer population. Under treatment, a significant part of them (at least 30%) can experience a flare of their baseline disease which can sometime be severe. Life-threatening cases seems rare and disease flare can be generally managed with steroids. The volume of available data is more important for rheumatologic diseases than for inflammatory bowel diseases were more caution should be observed. However, it has to be kept in mind that new immune related adverse effects (IrAE) are seen with a similar frequency as the flare of the baseline disease. Both flare-up's and newly developed IrAE are generally manageable with a careful clinical follow-up and prompt therapy.
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Affiliation(s)
- Michelle Coureau
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Berghmans
- Service d'Oncologie Medicale, Unité d'Oncologie Thoracique, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Sanchis-Borja M, Ricordel C, Chiappa AM, Hureaux J, Odier L, Jeannin G, Descourt R, Gervais R, Monnet I, Auliac JB, Chouaïd C. Encephalitis related to immunotherapy for lung cancer: Analysis of a multicenter cohort. Lung Cancer 2020; 143:36-39. [PMID: 32200139 DOI: 10.1016/j.lungcan.2020.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/23/2020] [Accepted: 03/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Using immune-checkpoint inhibitors (ICIs) to manage cancer is associated with various immune-related adverse events. Central and/or peripheral neurological disorders are rare and potentially serious. We analyzed the characteristics of non-small-cell lung cancer (NSCLC) patients who developed immune-related encephalitis under anti-programmed-death protein-1 or its ligand (PD-1/PD-L1). METHODS Clinical, biological and radiological characteristics of ICI-treated NSCLC patients with immune-related encephalitis, from 6 centers, were evaluated retrospectively. RESULTS The 6 centers included 9 patients: all men, all smokers, median (range) age 67 (48-77) years, 78% adenocarcinomas, first- or second-line ICI for 5 and 4 patients, respectively. Two patients had non-active cerebral metastases at ICI onset. A median of 5 (1-22) ICI infusions preceded neurological symptoms, the most frequent being confusion (78%), fever (45%) and cerebellar ataxia (33%). CSF analyses revealed a median white blood cell count of 22/mm3 (1-210/mm3), with hyperlymphocytosis in 8 patients and high protein levels in all. All bacteriological and virological analyses were negative. Cerebral MRI was considered normal for 5 patients; 4 patients had FLAIR hypersignals consistent with brain parenchyma inflammation. Three patients required intensive care. All patients received corticosteroids (different doses), a median of 8.5 (6-18) days post-onset. Corticosteroids achieved rapid symptom regression without sequelae in 8 patients. The last patient, with the longest time until corticosteroid introduction, died. ICIs were never restarted in any patient. CONCLUSION Immune encephalitis, a rare but serious complication of anti-PD-1/PD-L1 therapy, carries a good prognosis when managed with early corticosteroids.
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Affiliation(s)
- Mateo Sanchis-Borja
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France.
| | - Charles Ricordel
- Service de Pneumologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Anne Marie Chiappa
- Service de Pneumologie, Centre Hospitalier de Cornouailles, Quimper, France
| | - José Hureaux
- Service de Pneumologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Luc Odier
- Service de Pneumologie, Centre Hospitalier de Villefranche-sur-Soane, Villefranche-sur-Soane, France
| | - Gaelle Jeannin
- Service de Pneumologie, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France
| | - Renaud Descourt
- Service de Pneumologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Radj Gervais
- Service d'Oncologie, Centre Anti-Cancéreux François-Baclesse, Caen, France
| | - Isabelle Monnet
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France
| | - Jean-Bernard Auliac
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France
| | - Christos Chouaïd
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France
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Sun X, Tan J, Sun H, Liu Y, Guan W, Jia J, Wang Z. Anti-SOX1 Antibodies in Paraneoplastic Neurological Syndrome. J Clin Neurol 2020; 16:530-546. [PMID: 33029958 PMCID: PMC7541980 DOI: 10.3988/jcn.2020.16.4.530] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022] Open
Abstract
Anti-Sry-like high mobility group box (SOX) 1 antibodies (abs) are partly characterized onconeural autoantibodies (autoabs) due to their correlation with neoplastic diseases. Anti-SOX1 abs are associated with various clinical manifestations, including Lambert-Eaton myasthenic syndrome (LEMS) and paraneoplastic cerebellar degeneration (PCD). However, the clinical characteristics of patients with anti-SOX1 abs have not been described in detail. This review systematically explores the reported patients with anti-SOX1 abs and analyzes these cases for demographic characteristics, clinical features, coexisting neuronal autoabs, neuroimaging findings, treatment, and clinical outcomes. In addition, considering that PCD is the most common paraneoplastic neurological syndrome and that the association between PCD and anti-SOX1 abs remains unclear, we focus on the presence of autoabs in relation to PCD and associated tumors. PCD-associated autoabs include various intracellular autoabs (e.g., anti-Hu, anti-Yo, anti-Ri, and anti-SOX1) and cell-surface autoabs (anti-P/Q-type voltage-gated calcium channel). Commonly involved tumors in PCD are small-cell lung cancer (SCLC), gynecological, and breast tumors. LEMS is the most common clinical symptom in patients with anti-SOX1 abs, followed by PCD, and multiple neuronal autoabs coexist in 47.1% of these patients. SCLC is still the predominant tumor in patients with anti-SOX1 abs, while non-SCLC is uncommon. No consistent imaging feature is found in patients with anti-SOX1 abs, and there is no consensus on either the therapy choice or therapeutic efficacy. In conclusion, the presence of anti-SOX1 abs alone is a potential predictor of an uncommon paraneoplastic neurological disorder, usually occurring in the setting of LEMS, PCD, and SCLC. The detection of anti-SOX1 abs contributes to an early diagnosis of underlying tumors, given the diversity of clinical symptoms and the absence of characteristic neuroimaging features.
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Affiliation(s)
- Xuan Sun
- Geriatric Neurological Department of the Second Medical Centre, National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jiping Tan
- Geriatric Neurological Department of the Second Medical Centre, National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hui Sun
- Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Liu
- Geriatric Neurological Department of the Second Medical Centre, National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weiping Guan
- Geriatric Neurological Department of the Second Medical Centre, National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jianjun Jia
- Geriatric Neurological Department of the Second Medical Centre, National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zhenfu Wang
- Geriatric Neurological Department of the Second Medical Centre, National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Tan YY, Rannikmäe K, Steele N. Case report: immune-mediated cerebellar ataxia secondary to anti-PD-L1 treatment for lung cancer. Int J Neurosci 2019; 129:1223-1225. [PMID: 31414604 DOI: 10.1080/00207454.2019.1655013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Case presentation: A 66-year-old gentleman with metastatic non-small-cell lung cancer developed a wide-based gait following treatment on a clinical trial with cytotoxic chemotherapy and an anti-PD-L1 drug. He had no other significant past medical history of note. Brain imaging, blood tests and lumbar puncture did not reveal a structural, biochemical, paraneoplastic or infective cause. The main differential diagnoses were immune-mediated toxicity or a paraneoplastic syndrome. He was started on prednisolone on the suspicion that his symptoms represented an immune-mediated toxicity. His condition improved following this and his immunotherapy treatment was discontinued. Upon steroid withdrawal, his symptoms recurred and responded to further prednisolone. Conclusions: Immune-mediated toxicities can affect any part of the nervous system and should form part of the differential diagnosis for new neurological symptoms in a patient receiving immunotherapy. Corticosteroids should be the first-line treatment of immune-mediated toxicities. Immunotherapy should be permanently discontinued following severe toxicities.
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Affiliation(s)
- Yun Yi Tan
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre , Glasgow , Scotland
| | | | - Nicola Steele
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre , Glasgow , Scotland
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Aydin Ç, Çelik ŞY, İçöz S, Ulusoy C, Gündüz T, Demir GA, Kürtüncü M, Tüzün E. Prognostic Factors in Anti-Neuronal Antibody Positive Patients. Noro Psikiyatr Ars 2018; 55:189-194. [PMID: 30057463 PMCID: PMC6060648 DOI: 10.29399/npa.23033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/09/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Anti-neuronal antibodies (ANA) are found in paraneoplastic neurological syndrome and autoimmune encephalitis patients. Our aim was to analyze prognostic factors related with ANA seropositivity. METHODS Twenty-seven consecutive ANA seropositive patients were included in the study. ANA were detected by immunofluorescent staining, immunoblot and cell-based assay methods. All patients were followed with a standard treatment protocol. Clinical syndromes, tumor types, modified Rankin scores, cranial MRI and oligoclonal band (OCB) findings were recorded. Cases were divided into subgroups due to clinical-laboratory features and ANA types. Prevalence of good prognosis, response to treatment and survival were compared among these subgroups. RESULTS Patients showed antibodies to N-methyl-D-aspartate receptor (NMDAR) (6 cases), Hu (6 cases), Ma2 (5 cases), glutamic acid decarboxylase (GAD) (3 cases), Yo (3 cases), amphiphysin (1 case), gamma-amino butyric acid B receptor (GABABR) (1 case), Ri (1 case) and Zic4 (1 case). Associated neurological syndromes were limbic encephalitis (8 cases), subacute cerebellar degeneration (7 cases), brainstem encephalitis (5 cases), subacute sensory neuronopathy (4 cases), stiff-person syndrome (2 cases) and opsoclonus-myoclonus (1 case). A tumor (ductal breast, small cell lung cancer) was detected in six cases at first admission. Six patients died in an average follow-up time of 1.0±1.5 years. Detection of antibodies to extracellular or synaptic target antigens, but not presence of tumor, cranial MRI lesions or OCB, was associated with good prognosis and response to treatment. CONCLUSION NMDAR, Hu and Ma2-antibodies were the most prevalent ANA in this first antibody screening study in a Turkish cohort. Antibody type was determined to be the foremost prognostic factor in ANA seropositive cases.
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Affiliation(s)
- Çağla Aydin
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Şenay Yıldız Çelik
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Sema İçöz
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Canan Ulusoy
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Gülşen Akman Demir
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
| | - Erdem Tüzün
- Department of Neurology, Istanbul University, Faculty of Medicine, İstanbul, Turkey
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