Skip to main content Accessibility help
×
Home
  • Print publication year: 2008
  • Online publication date: August 2009

17 - Paraneoplastic disorders

Summary

Introduction

Neurological paraneoplastic disorders refer to non-metastatic disorders that are not attributable to the toxicity of cancer therapy, cerebrovascular disease, coagulopathy, infection, or toxic and metabolic causes. Paraneoplastic disorders can affect any part(s) of the central (CNS) or peripheral (PNS) nervous systems (Table 17.1). Patients can be roughly grouped into those with pure or relatively pure clinical involvement of one part of the nervous system, such as cerebellar degeneration or sensory neuronopathy, and those with signs and symptoms of a diffuse and multifocal “paraneoplastic encephalomyelitis” (Dropcho, 2002; Graus et al., 2004). Several syndromes should always raise the possibility of a paraneoplastic etiology, including Lambert–Eaton myasthenic syndrome, subacute cerebellar degeneration, severe sensory neuronopathy, limbic encephalopathy, and opsoclonus-myoclonus. None of the clinical syndromes, however, have an absolute association with neoplasia, and each can occur in patients without tumors.

For any paraneoplastic neurological disorder, there is a clear over-representation of one or a few particular neoplasms. Overall, small cell lung carcinoma is the tumor most often associated with paraneoplastic phenomena in adults, although the actual incidence of paraneoplastic disorders among patients with this tumor is probably no more than 1%–3%. Other tumors over-represented among adults with paraneoplastic syndromes include breast carcinoma, ovarian carcinoma, Hodgkin's lymphoma, thymoma, and testicular germ cell tumors. Except for opsoclonus-myoclonus associated with neuroblastoma, paraneoplastic disorders in children are rare.

REFERENCES
Alamowitch, S, Graus, F, Uchuya, Met al. (1997). Limbic encephalitis and small cell lung cancer: clinical and immunological features. Brain 120: 923–928.
Ances, BM, Vitaliani, R, Taylor, RAet al. (2005). Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain 128: 1764–1777.
Anderson, NE, Budde-Steffen, C, Rosenblum, MKet al. (1988). Opsoclonus, myoclonus, ataxia, and encephalopathy in adults with cancer: a distinct paraneoplastic syndrome. Medicine 67: 100–109.
Antoine, JC, Honnorat, J, Anterion, CTet al. (1995). Limbic encephalitis and immunological perturbations in two patients with thymoma. J Neurol Neurosurg Psychiatry 58: 706–710.
Antoine, JC, Absi, L, Honnorat, Jet al. (1999). Antiamphiphysin antibodies are associated with various paraneoplastic neurological syndromes and tumors. Arch Neurol 56: 172–177.
Antunes, NL, Khakoo, Y, Matthay, KKet al. (2000). Antineuronal antibodies in patients with neuroblastoma and paraneoplastic opsoclonus-myoclonus. J Pediatr Hematol Oncol 22: 315–320.
Aydiner, A, Gurvit, H, Baral, I (1998). Paraneoplastic limbic encephalitis with immature ovarian teratoma. J Neuro-oncol 37: 63–66.
Bak, TH, Antoun, N, Balan, KK, Hodges, JR (2001). Memory lost, memory regained: neuropsychological findings and neuroimaging in two cases of paraneoplastic limbic encephalitis with radically different outcomes. J Neurol Neurosurg Psychiatry 71: 40–47.
Bakheit, AM, Kennedy, PG, Behan, PO (1990). Paraneoplastic limbic encephalitis: clinicopathologic correlations. J Neurol Neurosurg Psychiatry 53: 1084–1088.
Bataller, L, Wade, DF, Graus, Fet al. (2004). Antibodies to Zic4 in paraneoplastic neurological disorders and small cell lung cancer. Neurology 62: 778–782.
BehinA, A,Delattre, JY (2004). Complications of radiation therapy on the brain and spinal cord. Semin Neurol 24(4): 405–417.
Bell, BB, Tognoni, PG, Bihrle, R (1998). Limbic encephalitis as a paraneoplastic manifestation of renal cell carcinoma. J Urol 160: 828.
Benke, T, Wagner, M, Pallua, AKet al. (2004). Long-term cognitive and MRI findings in a patient with paraneoplastic limbic encephalitis. J Neurooncol 66: 217–224.
Bennett, JL, Galetta, SL, Frohman, LPet al. (1999). Neuro-ophthalmologic manifestations of a paraneoplastic syndrome and testicular carcinoma. Neurology 52: 864–867.
Bernal, F, Graus, F, Pifarre, Aet al. (2002). Immunohistochemical analysis of anti-Hu-associated paraneoplastic encephalomyelitis. Acta Neuropathol 103: 509–515.
Bien, CG, Schulze-Bonjage, A, Deckert, Met al. (2000). Limbic encephalitis not associated with neoplasm as a cause of temporal lobe epilepsy. Neurology 55: 1823–1828.
Blaes, F, Fuhlhuber, V, Korfei, Met al. (2005). Surface-binding autoantibodies to cerebellar neurons in opsoclonus syndrome. Ann Neurol 58: 313–317.
Bloch, MH, Hwang, WC, Baehring, JM, Chambers, SK (2004). Paraneoplastic limbic encephalitis: ovarian cancer presenting as an amnestic syndrome. Obstet Gynecol 104: 1174–1177.
Boltshauser, E, Deonna, T, Hirt, HR (1979). Myoclonic encephalopathy of infants, or “dancing eyes syndrome.”Helv Paediatr Acta 34: 119–133.
Brierley, JB, Corsellis, JA, Hierons, R, Nevin, S (1960). Subacute encephalitis of later adult life mainly affecting the limbic areas. Brain 83: 357–368.
Buckley, C, Oger, J, Clover, Let al. (2001). Potassium channel antibodies in two patients with reversible limbic encephalitis. Ann Neurol 50: 73–78.
Candler, PM, Dale, RC, Griffin, Set al. (2006). Post-streptococcal opsoclonus-myoclonus syndrome associated with anti-neuroleukin antibodies. J Neurol Neurosurg Psychiatry 77: 507–512.
Chan, KH, Vernino, S, Lennon, VA (2001). ANNA-3 anti-neuronal nuclear antibody: marker of lung cancer-related autoimmunity. Ann Neurol 50: 301–311.
Connolly, AM, Pestronk, A, Mehta, Set al. (1997). Serum autoantibodies in childhood opsoclonus-myoclonus syndrome: an analysis of antigenic targets in neural tissues. J Pediatr 130: 878–884.
Cooper, R, Khakoo, Y, Matthay, KKet al. (2001). Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: histopathologic features. Med Pediatr Oncol 36: 623–629.
Corsellis, JA, Goldberg, GJ, Norton, AR (1968). “Limbic encephalitis” and its association with carcinoma. Brain 91: 481–496.
Dalmau, J, Graus, F, Rosenblum, MK, Posner, JB (1992). Anti-Hu-associated paraneoplastic encephalomyelitis/sensory neuronopathy: a clinical study of 71 patients. Medicine 71: 59–72.
Dalmau, J, Graus, F, Villarejo, Aet al. (2004). Clinical analysis of anti-Ma2-associated encephalitis. Brain 127: 1831–1844.
Deodhare, S, O'Connor, P, Ghazarian, D, Bilbao, JM (1996). Paraneoplastic limbic encephalitis in Hodgkin disease. Can J Neurol Sci 23: 138–140.
Dirr, LY, Elster, AD, Donofrio, PD, Smith, M (1990). Evolution of brain MRI abnormalities in limbic encephalitis. Neurology 40: 1304–1306.
Dorresteijn, LD, Kappelle, AC, Renier, WO, Gijtenbeek, JM (2002). Anti-amphiphysin associated limbic encephalitis: a paraneoplastic presentation of small-cell lung carcinoma. J Neurol 249: 1307–1308.
Dropcho, EJ (2002). Remote neurologic manifestations of cancer. Neurol Clin 20 (1): 85–122.
Dropcho, EJ (2004). Neurotoxicity of cancer chemotherapy. Semin Neurol 24(4): 419–426.
Dropcho, EJ (2005). Immunotherapy for paraneoplastic neurological disorders. Expert Opin Biol Ther 5(10): 1339–1348.
Duyckaerts, C, Derouesne, C, Signoret, JLet al. (1985). Bilateral and limited amygdalohippocampal lesions causing a pure amnestic syndrome. Ann Neurol 18: 314–319.
Dyken, P, Kolar, O (1968). Dancing eyes, dancing feet: infantile polymyoclonus. Brain 91: 305–320.
Fakhoury, T, Abou-Khalil, B, Kessler, RM (1999). Limbic encephalitis and hyperactive foci on PET scan. Seizure 8: 427–430.
Farrugia, ME, Conway, R, Simpson, DJ, Kurian, KM (2005). Paraneoplastic limbic encephalitis. Clin Neurol Neurosurg 107: 128–131.
Fauser, S, Talazko, J, Wagner, Ket al. (2005). FDG-PET and MRI in potassium channel antibody-associated non-paraneoplastic limbic encephalitis. Acta Neurol Scand 111: 338–343.
Fisher, PG, Wechsler, DS, Singer, HS (1994). Anti-Hu antibody in a neuroblastoma-associated paraneoplastic syndrome. Pediatr Neurol 10: 309–312.
Fujii, N, Furuta, A, Yamaguchi, Het al. (2001). Limbic encephalitis associated with recurrent thymoma: a postmortem study. Neurology 57: 344–347.
Gambini, C, Conte, M, Bernini, Get al. (2003). Neuroblastic tumors associated with opsoclonus-myoclonus syndrome: histological, immunohistochemical and molecular features of 15 Italian cases. Virchows Arch 442: 555–462.
Graus, F, Keime-Guibert, F, Rene, Ret al. (2001). Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients. Brain 124: 1138–1148.
Graus, F, Delattre, JY, Antoine, JCet al. (2004). Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 75: 1135–1140.
Gultekin, SH, Rosenfeld, MR, Voltz, Ret al. (2000). Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain 123: 1481–1494.
Hammer, MS, Larsen, MB, Stack, CV (1995). Outcome of children with opsoclonus-myoclonus regardless of etiology. Pediatr Neurol 13: 21–24.
Hart, IK, Maddison, P, Newsom-Davis, Jet al. (2002). Phenotypic variants of autoimmune peripheral nerve hyperexcitability. Brain 125: 1887–1895.
Hayward, K, Jeremy, RJ, Jenkins, Set al. (2001). Long-term neurobehavioral outcome in children with neuroblastoma and opsoclonus-myoclonus-ataxia syndrome: relationship to MRI findings and anti-neuronal antibodies. J Pediatr 139: 552–559.
Henson, RA, Hoffman, HL, Urich, H (1965). Encephalomyelitis with carcinoma. Brain 88: 449–464.
Hersh, B, Dalmau, J, Dangond, Fet al. (1994). Paraneoplastic opsoclonus-myoclonus associated with anti-Hu antibody. Neurology 44: 1754–1755.
Hirayama, K, Taguchi, Y, Sato, M, Tsukamoto, T (2003). Limbic encephalitis presenting with topographical disorientation and amnesia. J Neurol Neurosurg Psychiatry 74: 110–112.
Hiyama, E, Yokoyama, T, Ichikawa, Tet al. (1994). Poor outcome in patients with advanced stage neuroblastoma and coincident opsomyoclonus syndrome. Cancer 74: 1821–1826.
Ingenito, GG, Berger, JR, David, NJ, Norenberg, MD (1990). Limbic encephalitis associated with thymoma. Neurology 40: 382.
Kaniecki, R, Morris, JC (1993). Reversible paraneoplastic limbic encephalitis. Neurology 43: 2418–2419.
Kararizou, E, Markou, I, Zalonis, Iet al. (2005). Paraneoplastic limbic encephalitis presenting as acute viral encephalitis. J Neurooncology 75: 229–232.
Keime-Guibert, F, Graus, F, Broet, Pet al. (1999). Clinical outcome of patients with anti-Hu-associated encephalomyelitis after treatment of the tumor. Neurology 53: 1719–1723.
Kinirons, P, Fulton, A, Keoghan, Met al. (2003). Paraneoplastic limbic encephalitis and chorea associated with CRMP-5 neuronal antibody. Neurology 61: 1623–1624.
Kinsbourne, M (1962). Myoclonic encephalopathy of infants. J Neurol Neurosurg Psychiatry 25: 271–276.
Kleopa, KA, Elman, LB, Lang, Bet al. (2006). Neuromyotonia and limbic encephalitis sera target mature Shaker-type K+ channels: subunit specificity correlates with clinical manifestations. Brain 129: 1570–1584.
Kodama, T, Numaguchi, Y, Gellad, FEet al. (1991). Magnetic resonance imaging of limbic encephalitis. Neuroradiology 33: 520–523.
Kohler, J, Hufschmidt, A, Hermle, Let al. (1988). Limbic encephalitis: two cases. J Neurooncology 20: 177–178.
Konczak, J, Schoch, B, Dimitrova, Aet al. (2005). Functional recovery of children and adolescents after cerebellar tumour resection. Brain 128: 1428–1441.
Korfei, M, Fuhlhuber, V, Schmidt, Tet al. (2005). Functional characterisation of autoantibodies from patients with pediatric opsoclonus-myoclonus syndrome. J Neuroimmunol 170: 150–157.
Kuban, KC, Ephros, MA, Freeman, RLet al. (1983). Syndrome of opsoclonus-myoclonus caused by Coxsackie B3 infection. Ann Neurol 13: 69–71.
Lacomis, D, Khoshbin, S., Schick, RM (1990). MR imaging of paraneoplastic limbic encephalitis. J Comput Assist Tomogr 14: 115–117.
Landolfi, JC, Nadkarni, M (2003). Paraneoplastic limbic encephalitis and possible narcolepsy in a patient with testicular cancer: case study. Neurooncology 5: 214–216.
Lawn, ND, Westmoreland, BF, Kiely, MJet al. (2003). Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis. Mayo Clin Proc 78: 1363–1368.
Lee, AC, Ou, Y, Lee, WK, Wong, YC (2003). Paraneoplastic limbic encephalitis masquerading as chronic behavioural disturbance in an adolescent girl. Acta Paediatr 92: 506–509.
Lee, EK, Maselli, RA, Agius, MA (1998). Morvan's fibrillary chorea: a paraneoplastic manifestation of thymoma. J Neurol Neurosurg Psychiatry 65: 857–862.
Liguori, R, Vincent, A, Clover, Let al. (2001). Morvan's syndrome: peripheral and central nervous system and cardiac involvement with antibodies to voltage-gated potassium channels. Brain 124: 2417–2426.
Linke, R, Schroeder, M, Helmberger, T, Voltz, R (2004). Antibody-positive paraneoplastic neurologic syndromes: value of CT and PET for tumor diagnosis. Neurology 63: 282–286.
Mihara, M, Sugase, S, Konaka, Ket al. (2005). The “pulvinar sign” in a case of paraneoplastic limbic encephalitis associated with non-Hodgkin's lymphoma. J Neurol Neurosurg Psychiatry 76: 882–884.
Mitchell, WG, Snodgrass, SR (1990). Opsoclonus-ataxia due to childhood neural crest tumors: a chronic neurologic syndrome. J Child Neurol 5: 153–158.
Mitchell, WG, Davalos, Y, Brumm, VLet al. (2002). Opsoclonus-ataxia caused by childhood neuroblastoma: developmental and neurologic sequelae. Pediatrics 109: 86–98.
Mitchell, WG, Brumm, VL, Azen, CGet al. (2005). Longitudinal neurodevelopmental evaluation of children with opsoclonus-ataxia. Pediatrics 116: 901–907.
Modrego, PJ, Cay, A, Pina, A, Monge, A (2002). Paraneoplastic subacute encephalitis caused by adenocarcinoma of prostate: a case report. Acta Neurol Scand 105: 351–353.
Moe, PG, Nellhaus, G (1970). Infantile polymyoclonia-opsoclonus syndrome and neural crest tumors. Neurology 20: 756–764.
Mori, M, Kuwabara, S, Yoshiyama, Met al. (2002). Successful immune treatment for non-paraneoplastic limbic encephalitis. J Neurol Sci 201: 85–88.
Na, DL, Hahm, DS, Park, JM, Kim, SE (2001). Hypermetabolism of the medial temporal lobe in limbic encephalitis on FDG-PET scan: a case report. Eur Neurol 45: 187–189.
Nokura, K, Yamamoto, H, Okawara, Yet al. (1997). Reversible limbic encephalitis caused by ovarian teratoma. Acta Neurol Scand 95: 367–373.
Ogata, M, Kikuchi, H, Satou, Tet al. (2006). Human herpesvirus 6 DNA in plasma after allogeneic stem cell transplantation: incidence and clinical significance. J Infect Dis 193: 68–79.
Okamura, H, Oomori, N, Uchitomi, Y (1997). An acutely confused 15-year-old girl. Lancet 350: 488.
Overeem, S, Dalmau, J, Bataller, Let al. (2004). Hypocretin-1 CSF levels in anti-Ma2 associated encephalitis. Neurology 62: 138–140.
Papero, PJ, Pranzatelli, MR, Margolis, LJet al. (1995). Neurobehavioral and psychological functioning of children with opsoclonus-myoclonus syndrome. Dev Med Child Neurol 37: 915–932.
Parisi, MT, Hattner, RS, Matthay, KKet al. (1993). Optimized diagnostic strategy for neuroblastoma in opsoclonus-myoclonus. J Nucl Med 34: 1922–1926.
Pelkofer, H, Schubart, AS, Hoftberger, Ret al. (2004). Modelling paraneoplastic CNS disease: T-cells specific for the onconeuronal antigen PNMA1 mediate autoimmune encephalitis in the rat. Brain 127: 1822–1830.
Petit, T, Janser, JC, Achour, NRet al. (1997). Paraneoplastic temporal lobe epilepsy and anti-Yo autoantibody. Ann Oncol 8: 919.
Petruzzi, MJ, Alarcon, PA (1995). Neuroblastoma-associated opsoclonus-myoclonus treated with intravenously administered immune globulin G. J Pediatr 127: 328–329.
Pittock, SJ, Kryzer, TJ, Lennon, VA (2004). Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol 56: 715–719.
Pittock, SJ, Lucchinetti, CF, Parisi, JEet al. (2005). Amphiphysin autoimmunity: paraneoplastic accompaniments. Ann Neurol 58: 96–107.
Plonquet, A, Gherardi, RK, Creange, Aet al. (2002). Oligoclonal T-cells in blood and target tissues of patients with anti-Hu syndrome. J Neuroimmunol 122: 100–105.
Plonquet, A, Garcia-Pons, F, Fernandez, Eet al. (2003). Peptides derived from the onconeural HuD protein can elicit cytotoxic responses in HHD mouse and human. J Neuroimmunol 142: 93–100.
Pohl, KR, Pritchard, J, Wilson, J (1996). Neurologic sequelae of the dancing eye syndrome. Eur J Pediatr 155: 237–244.
Pozo-Rosich, P, Clover, L, Saiz, Aet al. (2003). Voltage-gated potassium channel antibodies in limbic encephalitis. Ann Neurol 54: 530–533.
Pranzatelli, MR, Hyland, K, Tate, EDet al. (2004a). Evidence of cellular immune activation in children with opsoclonus-myoclonus: cerebrospinal fluid neopterin. J Child Neurol 19: 919–924.
Pranzatelli, MR, Travelstead, AL, Tate, EDet al. (2004b). B- and T-cell markers in opsoclonus-myoclonus syndrome: immunophenotyping of CSF lymphocytes. Neurology 62: 1526–1532.
Pranzatelli, MR, Tate, ED, Dukart, WSet al. (2005a). Sleep disturbance and rage attacks in opsoclonus-myoclonus syndrome: response to trazodone. J Pediatr 147: 372–378.
Pranzatelli, MR, Tate, ED, Travelstead, ALet al. (2005b). Mycophenolate reduces CSF T-cell activation and is a steroid sparer in opsoclonus-myoclonus syndrome (abstract). Ann Neurol 58 [Suppl. 9]: S111.
Pranzatelli, MR, Tate, ED, Travelstead, ALet al. (2005c). Cyclophosphamide therapy in pediatric opsoclonus-myoclonus syndrome [abstract]. Ann Neurol 58 [Suppl. 9]: S90.
Pranzatelli, MR, Tate, ED, Travelstead, AL, Longee, D (2005d). Immunologic and clinical responses to rituximab in a child with opsoclonus-myoclonus syndrome. Pediatrics 115: e115–119.
Provenzale, JM, Barboriak, DP, Coleman, RE (1998). Limbic encephalitis: comparison of FDG PET and MR imaging findings. AJR Am J Roentgenol 170: 1659–1660.
Ravizza, SM, McCormick, CA, Schlerf, JEet al. (2006). Cerebellar damage produces selective deficits in verbal working memory. Brain 129: 306–320.
Rickman, OB, Parisi, JE, Yu, Zet al. (2000). Fulminant autoimmune cortical encephalitis associated with thymoma treated with plasma exchange. Mayo Clin Proc 75: 1321–1326.
Ridley, A, Kennard, C, Scholtz, CLet al. (1987). Omnipause neurons in two cases of opsoclonus associated with oat cell carcinoma of the lung. Brain 110: 1699–1709.
Roberts, WK, Darnell, RB (2004). Neuroimmunology of the paraneoplastic neurological degenerations. Curr Opin Immunol 16: 616–622.
Rojas, I, Graus, F, Keime-Guibert, Fet al. (2000). Long-term clinical outcome of paraneoplastic cerebellar degeneration and anti-Yo antibodies. Neurology 55: 713–715.
Ronning, C, Sundet, K, Due-Tonnessen, Bet al. (2005). Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood. Pediatr Neurosurg 41: 15–21.
Rosenbaum, T, Gartner, J, Korholz, Det al. (1998). Paraneoplastic limbic encephalitis in two teenage girls. Neuropediatrics 29: 159–162.
Rosenfeld, MR, Eichen, JG, Wade, DFet al. (2001). Molecular and clinical diversity in paraneoplastic immunity to Ma proteins. Ann Neurol 50: 339–348.
Rostasy, K, Behnisch, W, Kulozik, Aet al. (2005). High-dose pulsatile dexamethasone therapy in children with opsoclonus-myoclonus syndrome [abstract]. Ann Neurol 58 [Suppl. 9]: S109.
Rousseau, A, Benyahia, B, Dalmau, Jet al. (2005). T-cell response to Hu-D peptides in patients with anti-Hu syndrome. J Neurooncology 71: 231–236.
Rudnick, E, Khakoo, Y, Antunes, NLet al. (2001). Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: clinical outcome and antineuronal antibodies: a report from the Children's Cancer Group. Med Pediatr Oncol 36: 612–622.
Russo, C, Cohn, SL, Petruzzi, MJ, Alarcon, PA (1997). Long-term neurologic outcome in children with opsoclonus-myoclonus associated with neuroblastoma: a report from the Pediatric Oncology Group. Med Pediatr Oncol 29: 284–288.
Sahashi, K, Sakai, K, Mano, K, Hirose, G (2003). Anti-Ma2 antibody related paraneoplastic limbic/brain stem encephalitis associated with breast cancer expressing Ma1, Ma2, and Ma3 mRNAs. J Neurol Neurosurg Psychiatry 74: 1332–1335.
Scheid, R, Voltz, R, Guthke, Tet al. (2003). Neuropsychiatric findings in anti-Ma2-positive paraneoplastic limbic encephalitis. Neurology 61: 1159–1160.
Scheid, R, Honnorat, J, Delmont, Eet al. (2004a). A new anti-neuronal antibody in a case of paraneoplastic limbic encephalitis associated with breast cancer. J Neurol Neurosurg Psychiatry 75: 338–340.
Scheid, R, Lincke, T, Voltz, Ret al. (2004b). Serial FDG positron emission tomography and magnetic resonance imaging of paraneoplastic limbic encephalitis. Arch Neurol 61: 1785–1789.
Shapiro, B, Shulkin, BL, Hutchinson, RJet al. (1994). Locating neuroblastoma in the opsoclonus-myoclonus syndrome. J Nucl Biol Med 38: 545–555.
Sheth, RD, Horwitz, SJ, Aronoff, Set al. (1995). Opsoclonus myoclonus syndrome secondary to Epstein-Barr virus infection. J Child Neurol 10: 297–299.
Sillevis Smitt, P, Grefkens, J, Leeuw, Bet al. (2002). Survival and outcome in 73 anti-Hu positive patients with paraneoplastic encephalomyelitis/sensory neuronopathy. J Neurol 249: 745–753.
Solomon, GE, Chutorian, AM (1968). Opsoclonus and occult neuroblastoma. N Engl J Med 279: 475–477.
Stern, RC, Hulette, CM (1999). Paraneoplastic limbic encephalitis associated with small cell carcinoma of the prostate. Mod Pathol 12: 814–818.
Sutton, I, Winer, J, Rowlands, D, Dalmau, J (2000). Limbic encephalitis and antibodies to Ma2: a paraneoplastic presentation of breast cancer. J Neurol Neurosurg Psychiatry 69: 266–268.
Sutton, RC, Lipper, MH, Brashear, HR (1993). Limbic encephalitis occurring in association with Alzheimer's disease. J Neurol Neurosurg Psychiatry 56: 808–811.
Tabarki, B, Palmer, P, Lebon, P, Sebire, G (1998). Spontaneous recovery of opsoclonus-myoclonus syndrome caused by enterovirus infection. J Neurol Neurosurg Psychiatry 64: 406–422.
Tattevin, P, Schortgen, F, Broucker, Tet al. (2001). Varicella-zoster virus limbic encephalitis in an immunocompromised patient. Scand J Infect Dis 33: 786–788.
Taylor, RB, Mason, W, Kong, K, Wennberg, R (1999). Reversible paraneoplastic encephalomyelitis associated with a benign ovarian teratoma. Can J Neurol Sci 26: 317–320.
Telander, RL, Smithson, WA, Groover, RV (1989). Clinical outcome in children with acute cerebellar encephalopathy and neuroblastoma. J Pediatr Surg 24: 11–14.
Tersak, JM, Safier, RA, Schor, NF (2005). Rituximab in the treatment of refractory neuroblastoma-associated opsoclonus-myoclonus syndrome [abstract]. Ann Neurol 58 [Suppl. 9]: S111.
Thieben, MJ, Lennon, VA, Boeve, BFet al. (2004). Potentially reversible autoimmune limbic encephalitis with neuronal potassium channel antibody. Neurology 62: 1177–1182.
Thuerl, C, Muller, K, Laubenberger, Jet al. (2003). MR imaging of autopsy-proven paraneoplastic limbic encephalitis in non-Hodgkin lymphoma. AJNR Am J Neuroradiol 24: 507–510.
Tomimitsu, H, Arimura, K, Nagado, Tet al. (2004). Mechanism of action of voltage-gated K+ channel antibodies in acquired neuromyotonia. Ann Neurol 56: 440–444.
Tsukamoto, T, Mochizuki, R, Mochizuki, Het al. (1993). Paraneoplastic cerebellar degeneration and limbic encephalitis in a patient with adenocarcinoma of the colon. J Neurol Neurosurg Psychiatry 56: 713–716.
Veneselli, E, Conte, M, Biancheri, Ret al. (1998). Effect of steroid and high-dose immunoglobulin therapy on opsoclonus-myoclonus syndrome occurring in neuroblastoma. Med Pediatr Oncol 30: 15–17.
Vernino, S, Lennon, VA (2000). New Purkinje cell antibody (PCA-2): marker of lung cancer-related neurological autoimmunity. Ann Neurol 47: 297–305.
Vernino, S, Lennon, VA (2004). Autoantibody profiles and neurological correlations of thymoma. Clin Cancer Res 10: 7270–7275.
Vernino, S, Eggenberger, ER, Rogers, LR, Lennon, VA (2002). Paraneoplastic neurological autoimmunity associated with ANNA-1 autoantibody and thymoma. Neurology 59: 929–932.
Vincent, A, Buckley, C, Schott, Jet al. (2004). Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain 127: 701–712.
Vitaliani, R, Mason, W, Ances, Bet al. (2005). Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol 58: 594–604.
Voltz, RD, Gultekin, HS, Rosenfeld, MRet al. (1999). A serologic marker of paraneoplastic limbic and brain-stem encephalitis in patients with testicular cancer. New Engl J Med 340: 1788–1795.
Wainwright, MS, Martin, PL, Morse, RPet al. (2001). Human herpesvirus 6 limbic encephalitis after stem cell transplantation. Ann Neurol 50: 612–619.
Waragi, M, Chiba, A, Uchibori, Aet al. (2006). Anti-Ma2 associated paraneoplastic neurological syndrome presenting as encephalitis and progressive muscular atrophy. J Neurol Neurosurg Psychiatry 77: 111–113.
Wingerchuk, DM, Noseworthy, JH, Kimmel, DW (1998). Paraneoplastic encephalomyelitis and seminoma: importance of testicular ultrasonography. Neurology 51: 1504–1507.
Wong, AM, Musallam, S, Tomlinson, RDet al. (2001). Opsoclonus in three dimensions: oculographic, neuropathologic and modelling correlates. J Neurol Sci 189: 71–81.
Yiu, VW, Kovithavongs, T, McGonigle, LF, Ferreira, P (2001). Plasmapheresis as an effective treatment for opsoclonus-myoclonus syndrome. Pediatr Neurol 24: 72–74.
Younes-Mhenni, S, Janier, MF, Cinotti, Let al. (2004). FDG-PET improves tumour detection in patients with paraneoplastic neurological syndromes. Brain 127: 2331–2338.
Yu, Z, Kryzer, TJ, Griesmann, GEet al. (2001). CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 49: 146–154.
Ziter, FA, Bray, PF, Cancilla, PA (1979). Neuropathologic findings in a patient with neuroblastoma and myoclonic encephalopathy. Arch Neurol 36: 51.