Neurologic Syndromes

Paraneoplastic manifestations of the central nervous system, while being quite rare, tend to occur more commonly in the course of HD than with any other hema-tological neoplasm. Paraneoplastic cerebellar degeneration (PCD) and paraneoplastic limbic encephalitis (PLE) are two distinct syndromes that deserve mention. HD is the most common hematologic malignancy associated with PCD,125 which occurs in about 0.5% of patients with HD.126 It has been reported in all phases of the disease and is characterized by the symptom complex of dysarthria, nystagmus, ataxia, and intention tremor. The pathogenesis involves Purkinje cell destruction in the cerebellum by antineuronal antibodies such as anti-Tr antibodies127 128 and anti-mGluR1 antibodies129 in HD. PLE is more infrequent than PCD, and HD accounts for 4-7% of this rare disorder.130 While anti-Hu and anti-Ta antibodies have been described in patients with PLE in the context of other solid tumors, no specific antibodies have been identified in patients with PLE in the setting of HD. Personality changes, depression, memory loss, cognitive impairment, and occasionally psychosis are the predominant clinical manifestations. Prognosis is poor, and neurological improvement is rare.

As a group, peripheral neuropathy is probably the most common paraneoplastic manifestation of hemato-logical malignancies, most often occurring in patients with lymphoma. In the majority of cases, these neuropathies tend to be a direct consequence of the cancer (nerve compression by tumor, immunoglobulin deposition, or treatment toxicity) rather than paraneoplastic. However, when it occurs, paraneoplastic neuropathy can manifest either as an indolent process, as in chronic inflammatory demyelinating polyneuropathy, or in a more acute fashion as Guillain-Barre syndrome.131-133 In patients who have high monoclonal paraprotein IgM in the setting of either Waldenstrom's macroglobulinemia, multiple myeloma, or occasionally NHL, a debilitating peripheral neuropathy can develop as a consequence of anti-myelin associated glycoprotein antibodies (anti-MAG antibodies).134 A variety of therapies have been used with limited success in the treatment of these neuropathies and include IVIg, plasmapheresis, corticos-teroids, cyclophosphamide, fludarabine, interferon, and rituximab.

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Peripheral Neuropathy Natural Treatment Options

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