Paraneoplastic Cerebellar Degeneration Treatment & Management

Updated: Nov 04, 2014
  • Author: Abbas Mehdi, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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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. [27]

  • 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.

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Surgical Care

Surgical care is required for patients who undergo tumor resection.

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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.

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Diet

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

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Activity

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

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