Treatment of neurological paraneoplastic syndromes involves treating the cancer and, in some cases, suppressing the immune response that's causing your signs and symptoms. Your treatment will depend on the specific type of paraneoplastic syndrome you have, but it may include the following options.
In addition to drugs, such as chemotherapy, to combat your cancer, your doctor may prescribe one or more of the following drugs to stop your immune system from attacking your nervous system:
- Corticosteroids, such as prednisone, inhibit inflammation. Serious long-term side effects include weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol and others.
- Immunosuppressants slow the production of disease-fighting white blood cells. Side effects include an increased risk of infections. Drugs may include azathioprine (Imuran) and cyclophosphamide (Cytoxan).
Depending on the type of neurological syndrome and symptoms, other medications may include:
- Anti-seizure medications, which may help control seizures associated with syndromes that cause electrical instability in the brain.
- Medications to enhance nerve to muscle transmission, which 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. Technicians return your red and white blood cells, along with your platelets, to your body, while discarding the plasma, which contains unwanted antibodies, and replacing it with other fluids.
- Intravenous immunoglobulin (IVIG). Immunoglobulin contains healthy antibodies from blood donors. High doses of immunoglobulin speed up the destruction of the damaging antibodies in your blood.
Other therapies may be helpful if a paraneoplastic syndrome has caused significant disability:
April 30, 2014
- Physical therapy. Specific exercises may help you regain some muscle function that has been damaged.
- Speech therapy. If you are having trouble speaking or swallowing, a speech therapist can help you relearn the necessary muscle control.
- NINDS paraneoplastic syndrome information page. National Institutes of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/paraneoplastic/paraneoplastic.htm. Accessed Dec. 18, 2013.
- Niederhuber JE, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Dec. 15, 2013.
- Pelosof LC, et al. Paraneoplastic syndromes: An approach to diagnosis and treatment. Mayo Clinic Proceedings. 2010;85:838.
- Giometto B, et al. Treatment for paraneoplastic neuropathies (Review). Cochrane Database of Systematic Reviews. http://ovidsp.tx.ovid.com/sp-3.10.0b/ovidweb.cgi?&S=BOJHFPHGIFDDNBEPNCNKNAIBLMNOAA00&Link+Set=S.sh.18%7c1%7csl_50. Accessed Dec. 18, 2013.
- Titulaer MJ, et al. Screening for tumours in paraneoplastic syndromes: Report of an EFNS Task Force. European Journal of Neurology. 2011;18:19.
- Graus F, et al. Paraneoplastic neurological syndromes. Current Opinion in Neurology. 2012;25:795.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014.
https://www.clinicalkey.com. Accessed Dec. 15, 2013.
- Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Dec. 15, 2013.
- Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Dec. 15, 2013.
- van Sonderen A, et al. Paraneoplastic syndromes of the neuromuscular junction: Therapeutic options in myasthenia gravis, Lambert-Eaton myasthenic syndrome, and neuromyotonia. Current Treatment Options in Neurology. 2013;15:224.
- Tarin D. Update on clinical and mechanistic aspects of paraneoplastic syndromes. Cancer Metastasis Review. 2013;32:707.
- Schramm N, et al. Detection of underlying malignancy in patients with paraneoplastic neurological syndromes: Comparison of 18F-FDG PET/CT and contrast-enhanced CT. European Journal of Nuclear Medicine and Molecular Imaging. 2013;40:1014.
- NINDS dysautonomia information page. National Institutes of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dysautonomia/dysautonomia.htm. Accessed Jan. 22, 2014.
- 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 Dec. 18, 2013.
- Dalmau J, et al. Overview of paraneoplastic syndromes of the nervous system. http://www.uptodate.com/home. Accessed Dec.18, 2013.
- Pittock SJ (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 14, 2010.
- U.S. News best hospitals 2013-2014. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/neurology-and-neurosurgery. Accessed Dec. 30, 2013.
- U.S. News best hospitals 2013-2014. U.S. News & World Report. http://health.usnews.com/best-hospitals/pediatric-rankings/neurology-and-neurosurgery. Accessed Dec. 30, 2013.
- Lachance DH (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 15, 2014.
- Eisen A. Disorders affecting the spinal cord. http://www.uptodate.com/home. Accessed Jan. 23, 2014.