Paraneoplastic neurological syndrome

Treatment of the neurological symptoms associated with paraneoplastic syndrome is complex and may involve oncologists, neuro-oncologists, neurologists and therapists.

Rapid diagnosis of the type of paraneoplastic syndrome present is important but identifying the underlying cancer, if possible, is vital. Early treatment can prevent further irreversible damage to nerves. If paraneoplastic antibodies are identified, they can provide clues to the cancer that may be responsible.

Treatments such as surgery, chemotherapy and radiotherapy are used first to treat the underlying cancer. Success here provides the best hope for reducing the symptoms of paraneoplastic neurological syndrome.

The second line of treatment is to try to modify the immune response that is causing the paraneoplastic syndrome:

• Plasmapheresis involves removing and replacing the plasma, which contains the paraneoplastic antibodies, from the blood of the person experiencing symptoms. Any effect is usually temporary as it does not stop the antibodies being produced.
• High dose intravenous immunoglobulin therapy can block the effects of the paraneoplastic antibodies.
• Immunosuppressant drugs such as steroids can help reduce symptoms in many paraneoplastic syndromes.

The presence or absence of specific paraneoplastic antibodies determines which treatment or treatment combinations are used. If none are found, sometimes these strategies will still be tried but, overall, the strategy of treating symptoms can have variable results.

The relationship between specific antibodies and specific paraneoplastic syndromes is becoming clearer but we do not fully understand this yet.

Support for paraneoplastic neurological syndromes

Occupational, speech and physical therapists often work together to tackle the communication and physical difficulties that emerge as paraneoplastic syndromes progress.

Physical therapy may help people regain some of their nerve and muscle functions or prevent further deterioration. Continuing physical therapy is important to reduce the impact of the illness on quality of life. Speech therapy can help with speech and communication difficulties, which are common in people with paraneoplastic neurological syndromes.