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Paraneoplastic syndromes affecting peripheral nerve and muscle

Josep Dalmau, MD, PhD
Myrna R Rosenfeld, MD, PhD
Section Editor
Lisa M DeAngelis, MD, FAAN, FANA
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 — Paraneoplastic subacute sensory neuronopathy typically presents with loss of vibratory and joint position sense and sensory ataxia; other sensory modalities are or soon become impaired as well. Electrophysiologic studies help distinguish the syndrome from a sensory polyneuropathy. Cerebrospinal fluid examination often reveals pleocytosis and elevated protein.

Most patients have small cell lung cancer and anti-Hu antibodies. Early diagnosis and treatment of the underlying tumor may result in neurologic stabilization or improvement; immunosuppressive therapy is usually ineffective. 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].

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Literature review current through: Nov 2017. | This topic last updated: Sep 06, 2017.
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