Paraneoplastic syndromes of the nervous system


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Treatments and drugs

By Mayo Clinic staff

Treatment of neurological paraneoplastic syndromes involves treating the cancer and, in some cases, suppressing the immune response that's causing the neurological signs and symptoms. Your treatment will depend on the specific type of paraneoplastic syndrome you have, but it may include the following options.

Medications
In addition to drugs, such as chemotherapy, to combat your cancer, your doctor may prescribe one or more of the following drugs to inhibit immune system attacks on the nervous system:

  • Corticosteroids, such as prednisone, inhibit inflammation. Long-term use of corticosteroids may cause weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol and other serious side effects.
  • Immunosuppressants inhibit the production of disease-fighting white blood cells. Side effects include an increased risk of infections. Drugs with immunosuppressant properties that may be used include azathioprine (Imuran) and cyclophosphamide (Cytoxan).

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

  • Anti-seizure medications may help control seizures associated with syndromes affecting nerve cells in the brain. A number of anti-seizure medications are available, including carbamazepine (Tegretol, Carbatrol, others) and valproic acid (Depakene, Stavzor).
  • Medications to enhance nerve to muscle transmission may improve symptoms of syndromes affecting muscle function. Some drugs, such as 3,4-diaminopyridine, enhance the release of a chemical messenger that transmits a signal from nerve cells to muscles. Other drugs, such as pyridostigmine (Mestinon, Regonol), prevent the breakdown of these chemical messengers.

Other medical treatments
Other treatments that may improve symptoms include:

  • Plasmapheresis. This process — also known as plasma exchange — separates the fluid part of the blood, called plasma, from your blood cells with a device known as a cell separator. The red and white blood cells, along with your platelets, are returned to your body, while the plasma, which contains unwanted antibodies, is discarded and replaced with other fluids.
  • Intravenous immune globulin (IVIg). Immune globulin contains healthy antibodies from blood donors. High doses of immune globulin accelerate the destruction of damaging antibodies in your blood.

Other therapies
Other therapies may be helpful if a paraneoplastic syndrome has caused impairments that disrupt functional abilities:

  • Physical therapy. Specific exercises may help you regain some muscle function that may have been damaged.
  • Speech therapy. If a paraneoplastic syndrome has affected your ability to speak or swallow, a speech therapist can help you relearn muscle control necessary for speech, chewing and eating.
Coping and support Tests and diagnosis
References
  1. NINDS paraneoplastic syndrome information page. National Institutes of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/paraneoplastic/paraneoplastic.htm. Accessed Oct. 4, 2010.
  2. Dalmau J, et al. Paraneoplastic neurologic syndromes. In: Abeloff M, et al., eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingston Elsevier; 2008. http://www.mdconsult.com/das/book/body/221079415-3/1062999853/1709/56.html#4-u1.0-B978-0-443-06694-8..50055-5--cesec11_1589. Accessed Oct. 4, 2010.
  3. Pelosof LC, et al. Paraneoplastic syndromes: An approach to diagnosis and treatment. Mayo Clinic Proceedings. 2010;85:838.
  4. Toothaker TB, et al. Paraneoplastic neurological syndromes: A review. Neurologist. Jan 2009;15:21.
  5. Dalmau J, et al. Paraneoplastic syndromes of the CNS. Lancet Neurology. 2008;7:327.
  6. Giglio P, et al. Neurologic complications of cancer and its treatment. Current Oncology Reports. 2010;12:50a.
  7. NINDS Isaac's syndrome information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/Isaacs_syndrome/Isaacs_syndrome.htm. Accessed Oct. 5, 2010.
  8. Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Oct. 5, 2010.
  9. Therapeutic hematheresis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec11/ch146/ch146f.html. Accessed Oct. 7, 2010.
  10. Passive immunization. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec14/ch169/ch169c.html?qt=immunoglobulin&alt=sh. Accessed Oct. 7, 2010.
  11. McKeon A, et al. Positron emission tomography-computed tomography in paraneoplastic neurologic disorders: Systematic analysis and review. Archives of Neurology. 2010;67:322.
  12. Pittock SJ, et al. Paraneoplastic Autoimmunity Affecting the Nervous System. In: Baehring JM, et al., eds. Brain Tumors: Practical Guide to Diagnosis and Management. New York, N.Y.: Informa Healthcare; 2007:515.
  13. Lachance DH, et al. Paraneoplastic neurological autoimmunity. In: Kalman B, et al., eds. Neuroimmunology in Clinical Practice. Hoboken, N.J.: Wiley-Blackwell; 2007:210.
  14. Harper CM, et al. Lambert-Eaton syndrome. In: Kaminski HJ. Current Clinical Neurology: Myasthenia Gravis and Related Disorders. Totowa, N.J.: Humana Press; 2009:269.
  15. Pittock SJ (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 14, 2010.
DS00840 March 3, 2011

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