managing paraneoplastic neurological disorders

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1、ManagingParaneoplasticNeurologicalDisorders　　LEARNINGOBJECTIVES　　Afterpletingthiscourse,thereadermunepathogenesisofparaneoplasticneurologicalsyndromes.　　Explaintheclinicalvalueofparaneoplasticantibodydetection.　　Describethegeneraltreatmentapproachtoparaneoplasticneurologicalsyndromes.　　AB

2、STRACT　　Paraneoplasticneurologicalsyndromes(PNS)areremoteeffectsofcancerthatarenotcausedbyinvasionofthetumororitsmetastases.ImmunologicfactorsappearimportantinthepathogenesisofPNSbecauseantineuronalautoantibodiesandT-cellresponsesagainstnervoussystemantigenshavebeendefinedformanyofthesedi

3、sorders.Theimmunologicresponseiselicitedbytheectopicexpressionofneuronalantigensbythetumor.Expressionoftheseso-called"onconeural"antigensislimitedtothetumorandthenervoussystemandsometimesalsothetestis.Atthetimeofpresentationoftheneurologicalsymptoms,mostpatientshavenotyetbeendiagnosedelyh

4、elpfulindiagnosinganothereasparaneoplastic.Inaddition,theparaneoplasticantibodiesmayalsodirectthesearchforanunderlyingneoplasm.Ontheotherhand,inpatientsknoayheraldrecurrenceofthetumororasecondtumor.Thenumberofparaneoplasticantibodiesisstillgroe,thetypeofantibody,andthepresenceorabsenceofc

5、ancer,patientsareclassifiedashavinga"definite"or"possible"PNS.DespitethepresumedautoimmuneetiologyofPNS,theresultsofvariousformsofimmunotherapyhavebeendisappointing,eexceptions.Rapiddetectionandimmediatetreatmentoftheunderlyingtumorappearstoofferthebestchanceofstabilizingthepatientandprev

6、entingfurtherneurologicaldeterioration.　　INTRODUCTION　　Paraneoplasticneurologicalsyndromes(PNS)areremoteeffectsofcancerthatare,bydefinition,causedneitherbyinvasionofthetumororitsmetastasesnorbyinfection,ischemia,metabolicandnutritionaldeficits,surgery,orotherformsoftumortreatment[1].Immun

7、ologicfactorsarebelievedtobeimportantinthepathogenesisofPNSbecauseantibodiesandT-cellresponsesagainstnervoussystemantigenshavebeendefinedformanyofthesedisorders[1].　　　　Presumably,theimmunologicresponseiselicitedbytheectopicexpressionofneuronalantigensbythetumor.Expr