Paraneoplastic Autonomic Neuropathy Follow-up

Updated: Oct 16, 2019
  • Author: Stacy E Dixon, MD, PhD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Follow-up

Further Outpatient Care

Custodial nursing home care may be needed if the autonomic failure is severe, and patients are bedridden and completely disabled.

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Further Inpatient Care

Typically, the disorder is progressive, although stabilization with antineoplastic therapy has been reported. Subsequent follow-up is devoted to assessing adequacy of blood pressure support and bowel and bladder management.

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Inpatient & Outpatient Medications

Medications are the same as those used in inpatient care, except doses are adjusted with time and disease progression. See article Idiopathic Orthostatic Hypotension and Other Autonomic Failure Syndromes for specific suggestions.

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Deterrence/Prevention

No known method is effective in deterring or preventing occurrence of autonomic paraneoplastic failure, except to prevent exposure to known carcinogens such as tobacco smoke.

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Complications

Sudden death, often due to cardiac causes, can occur. Intestinal pseudo-obstruction and urinary tract infections from incomplete bladder emptying are possible. Overheating due to reduced sweat function can occur in hot temperatures or with physical exertion.

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Prognosis

Prognosis is generally poor. Prompt and effective treatment of the underlying malignancy may arrest progression of autonomic dysfunction, but in many cases, no improvement occurs. Survival is dependent on underlying cancer, patient age, and extent of nervous system involvement. The median survival of all patients with paraneoplastic syndromes has been estimated to be 1 to 3 years. [7] The two major exceptions are LEMS and NMDA receptor antibody disease. In Lambert-Eaton myasthenic syndrome, effective treatment often results in remission of the mild autonomic symptoms and better than expected survival. [45, 46, 47] In NMDA receptor antibody disease, treatment results in recovery 75% of the time; however, this disease is still poorly characterized and likely underdiagnosed, so these numbers may change as more data become available. [22]

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