Paraneoplastic Neurological Disorders (PND)

Paraneoplastic neurological disorders (PND) & the Neuroimmunology laboratory

Paraneoplastic neurological diseases (PND) are called so because they are a side effect of an autoimmune response against a tumor within a tissue that affects the normal functioning of the nervous system. In the majority of cases, neurological symptoms precede the discovery of the tumor itself. The combination of cancerous disease with damage to the nervous system is extremely rare and does not necessarily accompany any person who has a tumor. The reaction is a result of the creation of antibodies or immune cells against one of the components of the cancerous cell which is by chance found normally in the cells of the nervous system. The infiltration of immune response to the brain causes extensive damage to neurons that is expressed by neurological deficiencies that characterize the nature of the injury.

The Neuroimmunology Laboratory examines six different antibodies that characterize various cancers. The attached table shows a description of the neurological signs accompanying each antibody and their linkage to tumors that accompany them. In every case of appearance of paraneoplastic antibody in the blood of the patient, it is suggested that the physician follow up with the patient and find the appropriate tumor, if this was not done previously. The rule is that if there is an antibody, there is also a tumor. We will bring two two of the more common antibodies as an example: anti Yo is an antibody that accompanies destruction of Purkinje cells in the cerebellum and is unique to breast and ovarian tumors. This antibody has been tested only in female patients. anti Hu is an antibody that is associated with massive destruction of neurons throughout the brain and is unique to a specific tumor of the lung. This antibody has been tested in both sexes. In addition, we perform testing of rare antibodies: anti Ri, anti CV2, anti amphyphisin, and anti Ma.

Table Autoantibody Clinical Presentation Commonly Associated Cancer(s)
Anti-Hu Encephalomyelitis, sensory neuronopathy Small Cell Lung Cancer (SCLC) and neuroblastoma
Anti-Ma Cerebellar dysfunction, brainstem dysfunction Breast, lung, colon7
Anti-Ta Limbic encephalitis, brainstem dysfunction Testicular
Anti-Yo Cerebellar degeneration Gynecologic, breast
Anti-Ri Cerebellar ataxia, opsoclonus Breast, gynecologic, SCLC
Anti-CAR Photoreceptor degeneration SCLC and others
Anti-VGCC Lambert-Eaton myasthenic syndrome SCLC