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Evidence-based Mental Health Nov 2019The awareness and understanding of autoimmune encephalitis are blossoming in neurology, and patients are being diagnosed and successfully treated with immunotherapy. The... (Review)
Review
The awareness and understanding of autoimmune encephalitis are blossoming in neurology, and patients are being diagnosed and successfully treated with immunotherapy. The diverse symptomatology associated with autoimmune encephalitis means that patients may present initially to mental health services, which are, as yet, less well equipped to identify and investigate such phenomena. Older adult mental health services are used to managing complexity, but the range of pathologies presenting with unusual symptoms that may mimic autoimmune encephalitis is wide and there is no clear guidance as to when and how to investigate for possible autoimmune encephalitis. This paper examines the evidence supporting investigation and management strategies for patients with possible autoimmune encephalitis presenting to older adult psychiatrists.
Topics: Aging; Autoimmune Diseases of the Nervous System; Humans; Limbic Encephalitis; Paraneoplastic Syndromes, Nervous System
PubMed: 31537612
DOI: 10.1136/ebmental-2019-300110 -
Internal Medicine (Tokyo, Japan) Dec 1996Paraneoplastic neurologic syndromes are degenerative diseases of the central or peripheral nervous system that develop in association with a systemic neoplasm without a... (Review)
Review
Paraneoplastic neurologic syndromes are degenerative diseases of the central or peripheral nervous system that develop in association with a systemic neoplasm without a direct invasion by tumor. The pathogenesis of this disorder has been hypothesized in the past, and now there is increasing evidence that autoimmune processes triggered by the underlying neoplasm play a major role in the pathophysiology, as documented by many reports of identification of autoantibodies that react with both the target neural tissue and the underlying neoplasm, as evidenced by the extensive application of molecular biology techniques. The presence of antibodies in serum or CSF of some patients with this disorder now accurately identifies the subgroup of the disorders related to specific neoplasms. The trend of recent studies on the pathogenesis of this disease may in the future lead to a new era to clarify the pathogenesis.
Topics: Amino Acid Sequence; Autoantibodies; Autoantigens; Base Sequence; Central Nervous System Diseases; ELAV Proteins; ELAV-Like Protein 3; Encephalomyelitis; Humans; Molecular Sequence Data; Nerve Tissue Proteins; Paraneoplastic Syndromes; RNA-Binding Proteins; Spinocerebellar Degenerations
PubMed: 9030988
DOI: 10.2169/internalmedicine.35.925 -
Mayo Clinic Proceedings Nov 2010
Topics: Dermatomyositis; Humans; Male; Middle Aged; Paraneoplastic Syndromes
PubMed: 21037040
DOI: 10.4065/mcp.2010.0514 -
Actas Dermo-sifiliograficas Sep 2013The skin can be key to early diagnosis of systemic malignancies. In the second part of this review, we present various skin conditions that can, in certain contexts,... (Review)
Review
The skin can be key to early diagnosis of systemic malignancies. In the second part of this review, we present various skin conditions that can, in certain contexts, reveal the presence of malignancy. The skin conditions are presented in groups based on a diverse range of morphological characteristics. Specifically, the following groups are analyzed: erosive and blistering lesions; inflammatory papules and nodules; xerosis, ichthyosis, and generalized exfoliative dermatitis; symptoms such as pruritus; abnormal hair distribution patterns; sweating disorders; benign tumors that can form part of hereditary syndromes associated with a risk of visceral cancer; and finally, oral and nail abnormalities. This review highlights the importance of the skin in the study of systemic malignancies.
Topics: Humans; Mouth Diseases; Nail Diseases; Neoplasms; Paraneoplastic Syndromes; Skin Diseases
PubMed: 23891448
DOI: 10.1016/j.adengl.2012.05.026 -
Current Opinion in Rheumatology Nov 2015Recent data suggest a paraneoplastic mechanism of scleroderma pathogenesis in unique subsets of scleroderma patients. In this article, we review these data, explore... (Review)
Review
PURPOSE OF REVIEW
Recent data suggest a paraneoplastic mechanism of scleroderma pathogenesis in unique subsets of scleroderma patients. In this article, we review these data, explore potential links between cancer and scleroderma, and propose an approach to malignancy screening in scleroderma.
RECENT FINDINGS
Emerging data have demonstrated that patients with scleroderma and RNA polymerase III autoantibodies have a significantly increased risk of cancer within a few years of scleroderma onset. Genetic alterations in the gene encoding RNA polymerase III (POLR3A) have been identified, and patients with somatic mutations in POLR3A have evidence of mutation specific T-cell immune responses with generation of cross-reactive RNA polymerase III autoantibodies. These data strongly suggest that scleroderma is a by-product of antitumor immune responses in some patients. Additional epidemiologic data demonstrate that patients developing scleroderma at older ages may also have a short cancer-scleroderma interval, suggestive of paraneoplastic disease.
SUMMARY
Scleroderma may be a paraneoplastic disease in unique patient subsets. Aggressive malignancy screening in these patients may aid in early cancer detection. Further study is required to determine whether cancer therapy could improve scleroderma outcomes in this patient population.
Topics: Early Detection of Cancer; Humans; Neoplasms; Paraneoplastic Syndromes; Scleroderma, Systemic
PubMed: 26352736
DOI: 10.1097/BOR.0000000000000222 -
Journal of the Royal College of... 1999Distinct syndromes are associated with a limited range of tumours. Autoantibodies are provoked by tumour (onconeural) antigens. Paraneoplastic antibodies to ion channels... (Review)
Review
Distinct syndromes are associated with a limited range of tumours. Autoantibodies are provoked by tumour (onconeural) antigens. Paraneoplastic antibodies to ion channels (VGCC, VGKC, AChR) are disease-inducing, but may also slow tumour growth in the case of LEMS. Antibodies to intracellular antigens in CNS disorders are probably not disease-inducing, but are valuable in diagnosis as disease markers. T cell mediated cytotoxicity is the likely effector mechanism in these latter disorders.
Topics: Antibodies, Neoplasm; Autoantibodies; Female; Humans; Male; Nervous System Diseases; Paraneoplastic Syndromes; Prognosis; Syndrome
PubMed: 10402568
DOI: No ID Found -
Acta Reumatologica Portuguesa 2006Links between rheumatic manifestations and neoplasms are today an evidence. Certain syndromes have epidemiologic studies confirming strong association with malignancy,... (Review)
Review
Links between rheumatic manifestations and neoplasms are today an evidence. Certain syndromes have epidemiologic studies confirming strong association with malignancy, such as dermatomyositis and polymyositis, hyperthrophic osteoarthropathy and Lambert - Eaton myasthenic syndrome. These disorders may mimic idiopathic conditions, difficulting diagnosis. Besides that, longstanding rheumatic syndromes may, in their course, behave like premalignant conditions, as a result of their pathophysiology or drugs used in their treatment. The mechanisms whereby the neoplasm leads to rheumatic symptoms are: direct invasion of the musculoskeletal system, synovial reaction of justa-articular bony or capsular carcinomatous, secondary gout and paraneoplastic manifestations. Neoplasms constitute an important admission cause in Internal Medicine wards and rheumatic manifestations are common causes of Internal Medicine and Rheumatology appointments. The objective of the present work is to review the literature concerning rheumatic syndromes more frequently associated with malignancy, characterizing features that may suggest the presence of a hidden neoplasm as well as the potential diagnostic and prognostic value of their presence in malignant diseases.
Topics: Humans; Neoplasms; Paraneoplastic Syndromes; Rheumatic Diseases; Vascular Diseases
PubMed: 17334043
DOI: No ID Found -
CA: a Cancer Journal For Clinicians 2009The skin often mirrors changes in the organism it envelops. Many neoplastic diseases that affect internal organs display cutaneous manifestations, which may be the... (Review)
Review
The skin often mirrors changes in the organism it envelops. Many neoplastic diseases that affect internal organs display cutaneous manifestations, which may be the presenting signs and symptoms of the underlying malignancy. These may reflect direct involvement of the skin by the tumor (ie, tumor metastasis) or indirect involvement, in which changes in the skin occur in the absence of malignant cells. This review focuses on the latter conditions, which are often referred to as paraneoplastic dermatoses. Included in the discussion are the cutaneous manifestations of inherited syndromes that are associated with an increased risk of internal malignancy, cutaneous changes in patients with hormone-secreting tumors, and the wide spectrum of proliferative and inflammatory dermatoses that have been associated with internal cancer.
Topics: Humans; Neoplasms; Paraneoplastic Syndromes; Skin Diseases
PubMed: 19258446
DOI: 10.3322/caac.20005 -
Journal of Nuclear Medicine : Official... Jul 2017The purpose of this study was to assess the diagnostic performance of whole-body F-FDG PET or F-FDG PET/CT for detection of underlying malignancy in patients with... (Comparative Study)
Comparative Study Meta-Analysis Review
The purpose of this study was to assess the diagnostic performance of whole-body F-FDG PET or F-FDG PET/CT for detection of underlying malignancy in patients with clinically suspected neurologic and nonneurologic paraneoplastic syndromes. A systematic search was performed in PubMed (Medline), Embase, and Scopus (last updated November 2016) to identify relevant published studies reporting the performance of F-FDG PET or F-FDG PET/CT in patients with suspected paraneoplastic syndrome. Histopathologic confirmation or clinical follow-up was considered as the reference standard. Pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, and diagnostic odds ratio were calculated. A summary receiver-operating-characteristic curve was constructed, and the area under the curve (AUC) was determined along with the Q* index. Twenty-one studies including a total of 1,293 individual patients suspected of having a paraneoplastic syndrome and who underwent F-FDG PET or F-FDG PET/CT examinations met our inclusion criteria. There was moderate to high heterogeneity among the included studies. The pooled sensitivity, specificity, and diagnostic odds ratio of F-FDG PET or F-FDG PET/CT for the detection of underlying malignancy were 0.81 (95% CI, 0.76-0.86), 0.88 (95% CI, 0.86-0.90), and 34.03 (95% CI, 18.76-61.72), respectively. The AUC and the Q* index were 0.916 (SE, 0.018) and 0.849, indicating excellent diagnostic accuracy. The diagnostic accuracy was slightly improved after studies with high applicability concerns were excluded (AUC, 0.931; SE, 0.020). In a subgroup analysis, F-FDG PET/CT was found to have a significantly higher specificity (0.89 vs. 0.79) than F-FDG PET alone, with no evidence of significant difference in the overall performance (AUC, 0.930 vs. 0.891; 2-tailed value for difference, 0.31). This meta-analysis of available studies demonstrates that whole-body F-FDG PET or F-FDG PET/CT has high diagnostic accuracy and moderate to high sensitivity and specificity for detection of underlying malignancy in patients suspected of having a paraneoplastic syndrome.
Topics: Fluorodeoxyglucose F18; Incidence; Paraneoplastic Syndromes; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prevalence; Prognosis; Radiopharmaceuticals; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Whole Body Imaging
PubMed: 27980049
DOI: 10.2967/jnumed.116.183905 -
Current Opinion in Immunology Dec 1995Fundamental advances in the fields of molecular biology and immunology have facilitated investigation of the autoimmune blistering disorders. Recently, the use of human... (Review)
Review
Fundamental advances in the fields of molecular biology and immunology have facilitated investigation of the autoimmune blistering disorders. Recently, the use of human autoantibodies has helped to identify biologically important adhesion molecules of the skin, and the pathogenic mechanisms involved in bullous skin diseases are now being precisely defined.
Topics: Aged; Animals; Autoantibodies; Cell Communication; Child; Child, Preschool; Dermatitis Herpetiformis; Disease Models, Animal; Epidermolysis Bullosa Acquisita; Female; Humans; Infant; Keratinocytes; Lupus Erythematosus, Systemic; Male; Mice; Models, Immunological; Paraneoplastic Syndromes; Skin Diseases, Vesiculobullous
PubMed: 8679130
DOI: 10.1016/0952-7915(95)80058-1