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Clinical Neuro-Oncology |
New Jersey Neuroscience Institute—JFK Medical Center, Edison, NJ 08818, and Seton Hall University School of Graduate Medical Education, South Orange, NJ 07079, USA
1 Address correspondence to Joseph C. Landolfi, Assistant Professor of Neurology, New Jersey Neuroscience Institute—JFK Medical Center, 65 James Street, Edison, NJ 08818, USA (jlandolfi{at}solarishs.org).
Abstract
We describe a patient who presented with a clinical syndrome of limbic encephalitis, narcolepsy, and cataplexy. The anti-Ma2 antibody was positive. Although there was no mass on imaging, orchiectomy was performed in this patient, and testicular carcinoma was found. This is the first known case of limbic encephalitis and anti-Ma2 antibody to be associated with cataplexy and possible narcolepsy. Neurological symptoms precede the diagnosis of cancer in 50% of patients with paraneoplastic syndromes, and clinicians are therefore strongly advised to evaluate patients with neurological symptoms for this condition.
References
Barnett, M., Prosser, J., Sutton, I., Halmagyi, G.M., Davies, L.,
Harper, C., and Dalmau, J. (2001) Paraneoplastic brain stem
encephalitis in a woman with anti-Ma2 antibody. J. Neurol.
Neurosurg. Psychiatry 70,222
-225.
Carskadon, M.A., Dement, W.C., Mitler, M.M., Roth, T., Westbrook, P.R., and Keenan, S. (1986) Guidelines for the multiple sleep latency test (MSLT): A standard measure of sleepiness. Sleep 9,519 -524.[ISI][Medline]
Dalmau, J., Gultekin, S.H., Voltz, R., Hoard, R., DesChamps, T.,
Balmaceda, C., Batchelor, T., Gerstner, E., Eichen, J., Frennier, J., Posner,
J.B., and Rosenfeld, M.R. (1999) Ma1, a novel neuron- and
testis-specific protein, is recognized by the serum of patients with
paraneoplastic neurological disorders. Brain
122, 27-39.
Dalmau, J., and Posner, J.B. (1997) Paraneoplastic syndromes affecting the nervous system. Semin. Oncol. 24,318 -328.[ISI][Medline]
Gultekin, S.H., Rosenfeld, M.R., Voltz, R., Eichen, J., Posner,
J.B., and Dalmau, J. (2000) Paraneoplastic limbic encephalitis:
Neurological symptoms, immunological findings and tumour association in 50
patients. Brain 123,1481
-1494.
Henson, R.A., and Urich, H. (1982) Cortical cerebellar degeneration. In: Henson, R.A., and Urich, H. (Eds.), Cancer and the Nervous System: The Neurological Manifestations of Systemic Malignant Disease. Oxford: Blackwell Scientific Publications, pp.346 -367.
Honda, Y., and Juji, T. (Eds.) (1988) HLA in Narcolepsy. Berlin: Springer-Verlag.
Obermeyer, W.H., and Benca, R.M. (1996) Effects of drugs on sleep. Neurol. Clin. 14,827 -840.[CrossRef][ISI][Medline]
Overeem, S., Mignot, E., van Dijk, J.G., and Lammers, G.J. (2002) Narcolepsy: Clinical features, new pathophysiological insights, and future perspectives. J. Clin. Neurophysiol. 18,78 -105.
Sammaritano, M., and Sherwin, A. (2000) Effect of anticonvulsants on sleep. Neurology 54 (Suppl. 1),S16 -S24.
Sutton, I., Winer, J., Rowlands, D., and Dalmau, J.
(2000) Limbic encephalitis and antibodies to Ma2: A
paraneoplastic presentation of breast cancer. J. Neurol. Neurosurg.
Psychiatr. 69,266
-268.
Thorpy, M. (2001) Current concepts in the etiology, diagnosis and treatment of narcolepsy. Sleep Med. 2, 5-17.[CrossRef][Medline]
Voltz, R., Gultekin, S.H., Rosenfeld, M.R., Gerstner, E., Eichen,
J., Posner, J.B., and Dalmau, J. (1999) A serologic marker of
paraneoplastic limbic and brain-stem encephalitis in patients with testicular
cancer. N. Engl. J. Med.
340,1788
-1795.
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