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Norrito RL, Puleo MG, Pintus C, Basso MG, Rizzo G, Di Chiara T, Di Raimondo D, Parrinello G, Tuttolomondo A. Paraneoplastic Cerebellar Degeneration Associated with Breast Cancer: A Case Report and a Narrative Review. Brain Sci 2024; 14:176. [PMID: 38391750 PMCID: PMC10887192 DOI: 10.3390/brainsci14020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Paraneoplastic neurological syndromes (PNSs) are an uncommon complication of cancer, affecting nearby 1/10,000 subjects with a tumour. PNSs can involve all the central and peripheral nervous systems, the muscular system, and the neuromuscular junction, causing extremely variable symptomatology. The diagnosis of the paraneoplastic disease usually precedes the clinical manifestations of cancer, making an immediate recognition of the pathology crucial to obtain a better prognosis. PNSs are autoimmune diseases caused by the expression of common antigens by the tumour and the nervous system. Specific antibodies can help clinicians diagnose them, but unfortunately, they are not always detectable. Immunosuppressive therapy and the treatment of cancer are the cornerstones of therapy for PNSs. This paper reports a case of PNSs associated with breast tumours and focuses on the most common paraneoplastic neurological syndromes. We report a case of a young female with a clinical syndrome of the occurrence of rigidity in the right lower limb with postural instability with walking supported and diplopia, with a final diagnosis of paraneoplastic cerebellar degeneration and seronegative rigid human syndrome associated with infiltrating ductal carcinoma of the breast.
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Affiliation(s)
- Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Puleo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Chiara Pintus
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Basso
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Giuliana Rizzo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Tiziana Di Chiara
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Domenico Di Raimondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Gaspare Parrinello
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
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Santoro JD, Kerr LM, Codden R, Casper TC, Greenberg BM, Waubant E, Kong SW, Mandl KD, Gorman MP. Increased Prevalence of Familial Autoimmune Disease in Children With Opsoclonus-Myoclonus Syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1079. [PMID: 34475249 PMCID: PMC8422990 DOI: 10.1212/nxi.0000000000001079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives Opsoclonus-myoclonus syndrome (OMS) is a rare autoimmune disorder associated with neuroblastoma in children, although idiopathic and postinfectious etiologies are present in children and adults. Small cohort studies in homogenous populations have revealed elevated rates of autoimmunity in family members of patients with OMS, although no differentiation between paraneoplastic and nonparaneoplastic forms has been performed. The objective of this study was to investigate the prevalence of autoimmune disease in first-degree relatives of pediatric patients with paraneoplastic and nonparaneoplastic OMS. Methods A single-center cohort study of consecutively evaluated children with OMS was performed. Parents of patients were prospectively administered surveys on familial autoimmune disease. Rates of autoimmune disease in first-degree relatives of pediatric patients with OMS were compared using Fisher exact t test and χ2 analysis: (1) between those with and without a paraneoplastic cause and (2) between healthy and disease (pediatric multiple sclerosis [MS]) controls from the United States Pediatric MS Network. Results Thirty-five patients (18 paraneoplastic, median age at onset 19.0 months; 17 idiopathic, median age at onset 25.0 months) and 68 first-degree relatives (median age 41.9 years) were enrolled. One patient developed systemic lupus erythematosus 7 years after OMS onset. Paraneoplastic OMS was associated with a 50% rate of autoimmune disease in a first-degree relative compared with 29% in idiopathic OMS (p = 0.31). The rate of first-degree relative autoimmune disease per OMS case (14/35, 40%) was higher than healthy controls (86/709, 12%; p < 0.001) and children with pediatric MS (101/495, 20%; p = 0.007). Discussion In a cohort of pediatric patients with OMS, there were elevated rates of first-degree relative autoimmune disease, with no difference in rates observed between paraneoplastic and idiopathic etiologies, suggesting an autoimmune genetic contribution to the development of OMS in children.
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Affiliation(s)
- Jonathan D Santoro
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA.
| | - Lauren M Kerr
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Rachel Codden
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Theron Charles Casper
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Benjamin M Greenberg
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Emmanuelle Waubant
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Sek Won Kong
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Kenneth D Mandl
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Mark P Gorman
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
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