TY - JOUR
T1 - Narcolepsy, REM sleep behavior disorder, and supranuclear gaze palsy associated with Ma1 and Ma2 antibodies and tonsillar carcinoma
AU - Adams, Chris
AU - McKeon, Andrew
AU - Silber, Michael H.
AU - Kumar, Rajeev
PY - 2011/4
Y1 - 2011/4
N2 - Objective: To describe a patient with diencephalic and mesencephalic presentation of aMa1 and Ma2 antibody-associated paraneoplastic neurological disorder. Design: Case report. Setting: The Colorado Neurological Institute Movement Disorders Center in Englewood, Colorado, and the Mayo Clinic in Rochester, Minnesota. Patient: A 55-year-old man with a paraneoplastic neurological disorder characterized by rapid eye movement sleep behavior disorder, narcolepsy, and a progressive supranuclear palsy-like syndrome in the setting of tonsillar carcinoma. Intervention: Immunotherapy for paraneoplastic neurological disorder, surgery and radiotherapy for cancer, and symptomatic treatment for parkinsonism and sleep disorders. Main Outcome Measures: Polysomnography, multiple sleep latency test, and neurological examination. Results: The cancer was detected at a limited stage and treatable. After oncological therapy and immunotherapy, symptoms stabilized. Treatment with modafinil improved daytime somnolence. Conclusions: Rapid onset and progression of multifocal deficits may be a clue to paraneoplastic etiology. Early treatment of a limited stage cancer (with or without immunotherapy) may possibly slow progression of neurological symptoms. Symptomatic treatment may be beneficial.
AB - Objective: To describe a patient with diencephalic and mesencephalic presentation of aMa1 and Ma2 antibody-associated paraneoplastic neurological disorder. Design: Case report. Setting: The Colorado Neurological Institute Movement Disorders Center in Englewood, Colorado, and the Mayo Clinic in Rochester, Minnesota. Patient: A 55-year-old man with a paraneoplastic neurological disorder characterized by rapid eye movement sleep behavior disorder, narcolepsy, and a progressive supranuclear palsy-like syndrome in the setting of tonsillar carcinoma. Intervention: Immunotherapy for paraneoplastic neurological disorder, surgery and radiotherapy for cancer, and symptomatic treatment for parkinsonism and sleep disorders. Main Outcome Measures: Polysomnography, multiple sleep latency test, and neurological examination. Results: The cancer was detected at a limited stage and treatable. After oncological therapy and immunotherapy, symptoms stabilized. Treatment with modafinil improved daytime somnolence. Conclusions: Rapid onset and progression of multifocal deficits may be a clue to paraneoplastic etiology. Early treatment of a limited stage cancer (with or without immunotherapy) may possibly slow progression of neurological symptoms. Symptomatic treatment may be beneficial.
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U2 - 10.1001/archneurol.2011.56
DO - 10.1001/archneurol.2011.56
M3 - Article
C2 - 21482933
AN - SCOPUS:79953901366
SN - 0003-9942
VL - 68
SP - 521
EP - 524
JO - Archives of neurology
JF - Archives of neurology
IS - 4
ER -