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Paraneoplastic syndromes affecting peripheral nerve and muscle

Josep Dalmau, MD, PhD
Myrna R Rosenfeld, MD, PhD
Section Editor
Patrick Y Wen, MD
Deputy Editor
April F Eichler, MD, MPH


Paraneoplastic neurologic syndromes are a heterogeneous group of neurologic disorders associated with systemic cancer and caused by mechanisms other than metastases, metabolic and nutritional deficits, infections, coagulopathy, or side effects of cancer treatment. These syndromes may affect any part of the nervous system from cerebral cortex to neuromuscular junction and muscle, either damaging one area or multiple areas.

This topic will review those syndromes affecting peripheral nerve and muscle. An overview of paraneoplastic syndromes and other paraneoplastic disorders are discussed separately. (See "Overview of paraneoplastic syndromes of the nervous system" and "Paraneoplastic syndromes affecting the spinal cord and dorsal root ganglia" and "Paraneoplastic cerebellar degeneration" and "Paraneoplastic and autoimmune encephalitis" and "Paraneoplastic visual syndromes".)


Subacute sensory neuronopathy — Subacute sensory neuronopathy is discussed separately. (See "Paraneoplastic syndromes affecting the spinal cord and dorsal root ganglia", section on 'Subacute sensory neuronopathy'.)

Chronic sensorimotor neuropathy — Chronic sensorimotor neuropathy is common in cancer patients. Approximately 10 to 15 percent of patients with solid tumors develop a clinically apparent paraneoplastic sensorimotor neuropathy [1,2], while up to 35 to 50 percent have subclinical abnormalities demonstrable on electrodiagnostic testing [3]. Symptoms typically develop in patients with advanced disease, well after the diagnosis of malignancy has been made. Most affected patients have lung cancer. Some believe the neuropathy may be nutritional [4].

Patients with chronic sensorimotor neuropathy are not very debilitated by their neurologic symptoms, which typically consist of mild to moderate distal symmetric sensorimotor deficits. Nerve conduction studies are consistent with an axonal neuropathy, but decreased conduction velocities such as with demyelination may be seen. The differential diagnosis includes side effects of cancer treatment and disorders unrelated to malignancy such as diabetes, alcoholism, and vitamin B12 deficiency. Anti-ganglioside antibodies have been identified in some patients; because they are also found in patients with non-paraneoplastic neuropathy, they are of uncertain significance [5].


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Literature review current through: Sep 2016. | This topic last updated: Oct 26, 2015.
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