Paraneoplastic autonomic dysfunction

Paraneoplastic autonomic disorders can be diverse in presentation, with clinical manifestations of autonomic over- or underactivity, and most frequently occur in conjunction with multifocal neurological findings (central, peripheral, or both), rather than as isolated phenomena. Evaluation with autonomic reflex screen, thermoregulatory sweat test, and other specialized autonomic and neurological testing are helpful diagnostically, and detected measures of abnormality serve as a baseline to assess treatment response. Paraneoplastic autoantibody testing (in serum, CSF or both) assists in establishing an autoimmune etiology and for prediction of associated cancer type. Antibody biomarkers are diverse and are incrementally discovered year-on-year, necessitating the use of neurological phenotype-specific diagnostic evaluations rather than individual physician-selected tests. Treatment response (to cancer treatment and immunotherapy) is variable, based on the autoantibody profile and clinical syndrome.