Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027066 (myoclonus)
 4,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report an autopsy case of paraneoplastic opsoclonus-myoclonus-ataxia syndrome associated with small cell carcinoma of the lung. Chemotherapy and lung lobectomy resulted in complete tumor remission and disappearance of myoclonus. However, emotional and behavioral disturbances relapsed and remitted associated with exacerbation of truncal ataxia and ocular flutter, which responded favorably to prednisolone. At autopsy, after 2 years and 11 months of illness, there was no recurrence of cancer. Neuropathologically, only the cerebellum was affected, with diffuse loss of Purkinje cells and dentate neurons, suggesting that the paraneoplastic cerebellar involvement may be responsible for the cognitive affective symptoms in our patient.
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PMID:Autopsy case of opsoclonus-myoclonus-ataxia and cerebellar cognitive affective syndrome associated with small cell carcinoma of the lung. 1753 81

Paraneoplastic neurological syndromes (PNS) are remote effects of cancer, which are not caused by invasion of the tumour or its metastasis, but presumably immunologic mediated. They developed in less than 1% of patients with systemic cancers, most Limbic encephalitis (LE) is the most common clinical paraneoplastic syndrome attainting the CNS (Central Nervous System), and it is characterized by involvement of hippocampus and amygdala; LE is also the only one with clearly defined imaging features. We report a 64 year old man, former smoker, which presented multiple paraneoplastic syndromes, namely LE, opsoclonus-myoclonus, subacute cerebellar degeneration, brainstem encephalitis, sensory-motor neuropathy and inappropriate antidiuretic hormone secretion syndrome (SIADH); these syndromes were identifiable in the clinical and imaging examination, confirmed by the neuro-pathological study. Magnetic Resonance Imaging disclosed on T2 weighted images bilateral hyperintensity within medial temporal lobes, hypothalamus, thalamus, brain stem, upper and medium cerebellar peduncles and upper cervical spinal cord. The underlying tumour was not found in imaging studies or in the autopsy examination. A mediastinal adenopathy depicted a metastasis from low differentiated neoplasm cells, with some signs of neuroendocrine differentiation. With this case we provide a comprehensive illustration of the PNS, from a clinical, imaging and pathological point of view. This report also emphasises the importance of a diagnosis based on early clinical and imaging findings, given that, in most cases the cancer is not apparent.
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PMID:[Multiple paraneoplastic syndromes occurring in the same patient: clinical, imaging and neuro-pathological documentation]. 1758 9

We describe a man of 59 years old, a smoker (20 cigarettes per day), without any pathologic background, with epilepsia partialis continua, with a relatively sudden appearance in the last 6 weeks. We wanted to find the cause of these prolonged focal seizures. The initial diagnosis of emergency was that of right side hemiballismus. The initial diagnosis on admission was prolonged right brachial myoclonus. Initially I was thinking of primary tumor or secondary one but paraclinic examinations excluded this diagnosis. After 5 months I repeated cerebral MRI scan which revealed left neoplasm of cavum. After another 6 months head and neck MRI described left rhinopharyngeal neoplasm with laterocervical adenopathies, cerebral metastases secondary to bronchopulmonary cancer with mediastinal invasion. The epilepsia partialis continua preceded by one year the primary neoplastic process.
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PMID:[Paraneoplastic syndrome presenting as epilepsia partialis continua]. 1829 93

Paraneoplastic opsoclonus-myoclonus syndrome (OMS) is associated with small cell lung cancer (SCLC) in adults. Without appropriate treatment for SCLC, all reported patients with SCLC and OMS have died of complications of OMS within 3 months of diagnosis. With appropriate treatment, about half of reported patients have had improvement in neurologic function, and several have become long-term survivors (6-84 months). We report a patient with SCLC who presented with OMS and was refractory to immunosuppressive therapy but responded rapidly to antineoplastic therapy and remains alive with no sign of SCLC recurrence and minimal residual neurologic deficits 30 months after diagnosis. In patients presenting with OMS, early recognition and treatment of the underlying malignancy probably improve the chances for recovery from the OMS with minimal deficit and ultimate survival.
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PMID:Long-term survival in paraneoplastic opsoclonus-myoclonus syndrome associated with small cell lung cancer. 1834 55

Methadone is generally believed to be devoid of neuroexcitatory properties, and its use is increasing. This paper reports two cases of myoclonus with high-dose parenteral methadone in patients with cancer under hospice care. This side effect may be dose related and/or due to the parenteral route of administration. Reduction of the dose and change of route was sufficient to eliminate the myoclonus while maintaining an adequate pain control. Possible mechanisms for methadone causing myoclonus include a redistribution of receptor saturation in the N-methyl-D-aspartate (NMDA) and delta receptors. Ketamine may be an option for patients with intractable pain who develop methadone-induced myoclonus.
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PMID:Myoclonus associated with high-dose parenteral methadone. 1871 74

Pain management is a central issue in the care of cancer patients in hospice services. Morphine is at present the first line opioid recommended. But when morphine is used in large doses, especially in renal patients, an active metabolite of morphine, morphine-6-glucoronide, may cause delirium and myoclonus and sometimes antagonize the analgesic effect of morphine. Both fentanyl and methadone have some potential advantages over morphine since they are longer-acting and have no active metabolites. However, large doses of fentanyl or long-acting morphine are expensive while methadone has an extremely low cost. We present our retroactive comparative observations in 50 cancer patients. Methadone was found to be as effective as morphine, transdermal fentanyl and common combinations of other opioids in controlling the types of cancer pain presented by patients in a hospice in the Northwestern Region of Puerto Rico. The use of methadone on elderly patients with cancer pain as first line therapy is growing in European and North-American hospices. Hospitals should add methadone to their therapeutic armamentarium and physicians should develop skills to use this long acting opioid.
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PMID:Methadone: an effective alternative to morphine for pain relief in cancer patients. 1922 8

The "new" antiepileptic drug levetiracetam has the unique mechanisms of antiepileptic activity. Various recent studies revealed its efficacy and safety in different forms of epilepsy both as a monotherapy and an additional therapy. The low frequency of side-effects and minimal interactions with other drugs allow to use levetiracetam in elderly patients and in patients with severe co-morbid diseases including AIDS and hepatitis C receiving the corresponding therapy. Moreover, the efficacy of levetiracepam in other neurological diseases: chronic headaches, i.e., migraine, neuropathic pain, including patients with cancer, movement disorders (myoclonus, dystonia and dyskinesia in Parkinson's disease, essential tremor, have been revealed.
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PMID:[The possibilities of using keppra (levetiracetam) in different neurological diseases]. 1943 Dec 51

Neurologic paraneoplastic syndromes (NPSs) result from damage to the nervous system due to the remote effects of cancer not related to metastasis, infection, or metabolic derangements. NPSs are rare, affecting 1 in 10,000 patients with cancer. Pathogenesis is likely related to the immune mechanisms: normal neural tissue is mistakenly attacked due to the similarity in the onconeural antigens expressed by the tumor cells. Among the various "classic" and other NPSs, this review focuses on paraneoplastic movement disorders, including ataxia due to cerebellar degeneration, stiff-person syndrome, opsoclonus-myoclonus syndrome, chorea, parkinsonism, and tremor. The recently described syndrome of paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis is also included, given that these patients have complex movements such as stereotypies and dyskinesias in addition to psychiatric symptoms, altered sensorium, and other neurologic signs. Although variable, treatment and prognosis of NPSs rely heavily on treatment of the underlying malignancy and immunotherapy.
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PMID:Paraneoplastic movement disorders. 1951 80

Paraneoplastic movement disorders are rare autoimmune nonmetastatic complications of cancer. Common paraneoplastic movement disorders include cerebellar syndrome, opsoclonus myoclonus, basal ganglia disorders, stiff person syndrome, and neuromyotonia. Syndromes usually present before cancer diagnosis and are commonly associated with one or more serum antibodies. Increasing numbers of antibodies have been identified (Hu, Yo, Ri, CV2, amphiphysin, Ma, Ta, Tr, NMDA, mGluR1, PCA2, ANNA-3, VGCCA). Antibodies are highly correlated with the likelihood of an underlying cancer and are closely associated with certain tumors. Clinical clues to paraneoplastic aetiology include speed of onset, severity, speed of progression, resistance to treatment, and more widespread neurological signs than one would expect from nonparaneoplastic aetiologies. Cancer should be sought in those with classical presentations and those with possible presentations who have paraneoplastic antibodies. If no tumor is found on initial investigation, interval screening is advisable. The most common associated cancers found are small cell lung cancer, breast, gynaecological, testicular, lymphoma, and thymoma. Early identification and treatment sometimes leads to neurological improvement and may improve cancer prognosis. Prognosis is dependent on the tumor type and its likely response to treatment.
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PMID:Paraneoplastic movement disorders. 1956 65

Paraneoplastic neurologic syndrome, a rare complication of carcinoma, includes various neurologic disorders, such as encephalomyelitis, paraneoplastic cerebellar degeneration, subacute sensory neuronopathy, retinal paraneoplastic syndrome, opsoclonus-myoclonus syndrome and stiff-person syndrome. Several antibodies to malignant tumor cells and neurons are detected in sera and cerebrospinal fluids of patients with this syndrome, however, there is no direct evidence of antiYo or antiHu antibodies' causative roles in neuronal loss. Recent studies showed cytotoxic T-cell activities against peptides of an antigen protein recognized by antibodies in the peripheral blood of patients with paraneoplastic cerebellar degeneration and antiYo antibodies, as well as in patients with antiHu syndrome. Treatment of paraneoplastic neurologic syndrome with plasmapheresis, immunosuppresive drugs, or intravenous immunoglobulin therapy has been attempted. Here, we discuss previous reports and theoretical treatments based on recent etiological hypothesis of paraneoplastic cerebellar degeneration.
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PMID:Pathogenesis and treatment of paraneoplastic neurologic syndrome. 1981 Sep 23


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