eMedicine Specialties > Neurology > Neuro-oncology

Paraneoplastic Cerebellar Degeneration: Treatment & Medication

Author: Abbas Mehdi, MD, Director, MDA Center of Central California; Consulting Staff, Department of Neurology, California Neurological Center, Inc
Coauthor(s): David Y Ko, MD, Associate Professor, Department of Neurology, University of Southern California Keck School of Medicine
Contributor Information and Disclosures

Updated: Jul 13, 2009

Treatment

Medical Care

Two approaches can be used to treat paraneoplastic neurologic syndrome. The first treatment is directed toward the underlying tumor, while the second approach is toward the autoimmune disease causing the cerebellar dysfunction.

Since neurologic paraneoplastic syndromes are immune-mediated, 2 distinct approaches to therapy have been reported: removal of the antigen source by treatment of the underlying tumors and suppression of the immune response. Immunosuppression can be beneficial for some conditions.20

  • Paraneoplastic syndromes are a therapeutic challenge for the neurologist, and treatment of paraneoplastic syndromes is generally unsatisfactory.
  • Early tumor detection and treatment should be the primary objective in these patients.
  • The response of the paraneoplastic neurologic syndromes to immunosuppressive agents or antitumor treatment is influenced greatly by the underlying neuropathology.
    • The effect of the combination of intravenous immunoglobulins (IVIG), cyclophosphamide, and methylprednisolone on the clinical course of patients with paraneoplastic neurologic syndrome or paraneoplastic cerebellar degeneration and antineuronal antibodies is unsatisfactory.
    • Some reports indicate partial or complete remission of cerebellar symptoms after treating the primary neoplasm. This has been observed only in small-cell carcinomas and is not reported in gynecologic malignancies.
    • In a minority of patients who are not disabled severely at the onset of treatment, a transient stabilization is possible and deserves further evaluation.

Surgical Care

Surgical care is required for patients who undergo tumor resection.

Consultations

A team approach is required in treating patients with paraneoplastic cerebellar degeneration.

  • Neurologic consultation is needed for basic workup and to exclude other possible causes of cerebellar dysfunction.
  • Oncology consultation is needed for tumor workup and treatment protocols.
  • Surgical consultation is needed in patients for whom tumor resection is recommended.

Diet

The patient may require nutritional support in severe cases of nausea and vomiting.

Activity

Bed rest is usual because patients with severe cerebellar dysfunction are at high risk of falls.

More on Paraneoplastic Cerebellar Degeneration

Overview: Paraneoplastic Cerebellar Degeneration
Differential Diagnoses & Workup: Paraneoplastic Cerebellar Degeneration
Treatment & Medication: Paraneoplastic Cerebellar Degeneration
Follow-up: Paraneoplastic Cerebellar Degeneration
Multimedia: Paraneoplastic Cerebellar Degeneration
References
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References

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Further Reading

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Keywords

paraneoplastic neurologic syndrome, PCD, breast cancer, ovarian cancer, uterine cancer, lung cancer, occult gynecologic cancers, malignancy, paraneoplastic cerebellar degeneration

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Contributor Information and Disclosures

Author

Abbas Mehdi, MD, Director, MDA Center of Central California; Consulting Staff, Department of Neurology, California Neurological Center, Inc
Abbas Mehdi, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

David Y Ko, MD, Associate Professor, Department of Neurology, University of Southern California Keck School of Medicine
David Y Ko, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Medical Association, and California Medical Association
Disclosure: Pfizer Honoraria Speaking and teaching; UCB Grant/research funds clinical trials; Johnson and Johnson Grant/research funds clinical trials

Medical Editor

Frederick M Vincent Sr, MD, Clinical Professor, Department of Neurology and Ophthalmology, Michigan State University Colleges of Human and Osteopathic Medicine
Frederick M Vincent Sr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College of Legal Medicine, American College of Physicians, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jorge Kattah, MD, Head, Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria
Jorge Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences
Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center
Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

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