2010, Number 3
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Rev Mex Neuroci 2010; 11 (3)
Neurological paraneoplastic syndromes (Part II): autonomic and peripheral nervous system
Cacho DB, Estañol VB
Language: Spanish
References: 143
Page: 226-233
PDF size: 72.87 Kb.
ABSTRACT
Neurological paraneoplastic syndromes (NPS) of the peripheral nervous system (NPS-PNS) comprise diseases of roots, plexus, peripheral nerve, neuromuscular union and muscle. NPS of the autonomic system may encompass sympathetic o parasympathic nervous system disorders, especially in the cardiovascular and gastrointestinal systems, all are associated with cancer or well-characterized antionconeural antibodies. The most common NPS-PNS include paraneoplastic sensitive neuronopathy (PSN) and Lambert-Eaton myasthenic syndrome (LES). PSN precedes up to 50-74% to a panencephalomielitis and often has anti-HU antibodies associated to small cell lung carcinoma. On the other hand, since its description LES is considered as a NPS classical syndrome. It is produce by a presynaptic failure due to antibodies antichannel of calcium dependent of voltage type V/Q required for acetylcholine liberation and associated to cancer in 40-60%. In this review, we describe in detail the NPS of the peripheral nervous and autonomic systems.
REFERENCES
McLeod JG. Paraneoplastic neuropathies. In: Dyck PJ, Thomas PK (Eds). Peripheral neuropathy. Philadelphia: Saunders, 1993; 2: 1583-90.
Antoine JC, Absi LPD, Honnorat JMD, et al. Antiamphiphysin Ant bodies Are Associated With Various Paraneoplastic Neurological Syndromes and Tumors. Arch Neurol 1999; 56:172-7.
Lipton RB, Galer BS, Dutcher JP, et al. Large and small fibre sensory dysfunction in patients with cancer. J Neurol Neurosurg Psychiatry 1991; 54: 706-9.
Denny-Brown D. Primary sensory neuropathy with muscular changes associated with carcinoma. J Neurol Neurosurg Psychiatry 1948; 11: 73-87.
Wanschitz J, Hainefellner JA, Kristoferitsch W, Drlicek M, Budka H. Ganglionitis in paraneoplastic subacute sensory neuronopathy: a morphologic study. Neurology 1997; 49: 1156-9.
Rosseasu A, Benyahia B, Dalmau J, et al. T cell response to Hu-D peptides in patients with anti-Hu syndrome. J Neurooncol 2005; 71: 231-6
Graus F, Cordon CC, Posner JB. Neuronal antinuclear antibody in sensory neuronopathy from lung cancer. Neurology 1985; 35: 538-43.
Falah M, Schiff D, Burns TM. Neuromuscular complications of cancer diagnosis and treatment. J Support Oncol 2005; 3: 271-82.
Chalk CH, Windebank AJ, Kimmel DW, et al. The distinctive clinical features of praneoplastic sensory neuronopathy. Can J Neurol Sci 1992; 19: 346-51
Camdessanché JP, Antoine JC, Honnorat J, et al. Paraneoplastic peripheral neuropathy associated with anti-Hu antibodies. Brain 2002;125: 166-75.
Wen PY, Schiff D. Neurologic Complications of Solid Tumors. Neurol Clin N Am 2003; 21: 107-40.
Briemberg HR, Amato AA. Neuromuscular complications of cancer. Neurol Clin N Am 2003; 21: 141-65.
Antoine JC, Camdessanché JP. Peripheral nervous system involvement in patients with cancer. Lancet Neurol 2007; 6: 75-86.
Voltz R. Paraneoplastic Neurological syndromes: an update on diagnosis, pathogenesis, and therapy. Lancet Neurol 2002; 1: 294-305.
Dalmau J, Rosenfeld M. Paraneoplastic neurologic syndromes. In: Abeloff M, et al. Abeloff´s Clinical Oncology. 4th Ed. Philadelphia: Elservier; 2008, p. 993-1006.
Bataller L, Dalmau J. Paraneoplastic Disorders of the Central Nervous System: Update on Diagnostic Criteria and Treatment. Semin Neurol 2004; 24(4): 461-71.
Bataller L, Dalmau J. Paraneoplastic Neurologic Syndromes: Approaches to Diagnosis and Treatment. Semin Neurol 2003; 23(2): 215-24.
Rees JH. Paraneoplastic Syndromes: When to suspect, how to confirm, and how to manage. J Neurol Neurosurg Pshychiatry 2004; 75: ii43-50.
Bataller L, Dalmau J. Paraneoplastic Neurologic Syndromes. Neurol Clin N Am 2003; 21: 221-47.
Oh SJ, Gürtekin Y, Dropcho EJ, et al. Anti-Hu antibody neuropathy: a clinical, electrophysiological and pathological study. Clin Neurophys 2005; 116: 28-34.
Vernino S. Paraneoplastic Disorders Affecting The Neuromuscular Junction or Anterior Horn Cell. Continuum Lifelong Learning Neurol 2009; 15(1):132- 46.
Floyd S, Butler MH, Cremona O, David C, et al. Expression of Amphiphysin I, an Autoantigen of Paraneoplastic Neurological Syndromes in Breast Cancer. Molecular Medicine 1998; 4: 29-39.
Honnorat J, Cartalat CS. Advances in paraneoplastic neurological syndromes. Curr Opin Oncol 16: 614-20.
Honnorat J, Byk T, Kusters I, et al. Ulip/SCRMP proteins are recognized by autoantibodies in paraneoplastic neurological syndromes. Eur J Neurosci 1999; 11: 4226-32
Pittock SJ, Kryzer TJ, Lennon VA. Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurology 2004; 56(5): 715-9.
Lennon VA. Paraneoplastic Autoant bodies: The case of a descriptive generic nomenclature. Neurology 1994; 44: 2236-40.
Dalmau J, Posner JB. Neurologic paraneoplastic antibodies (anti-Yo; anti- HU; anti-Ri) Neurology 1994; 44: 2241-6.
Dalmau J, Furneaux HM, Cordon CC, Posner JB. The expression of the Hu (paraneoplastic encephalomyelitis/sensory neuronopathy) antigen in human normal and tumor tissues. Am J Pathol 1992; 141: 881-6.
Dalmau J, Graus F, Rosenblum MK, Posner JB. Anti-HU-Associated Paraneoplastic Encephalomyelitis/Sensory Neuronopathy. Medicine 1992; 71: 59-72.
Rudnicki SA, Dalmau J. Paraneoplastic syndromes of the spinal cord, nerve and muscle. Muscle and Nerve 2000; 23: 1800-18.
Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoant bodies. Neurology 1998; 50: 652-7.
Kuntzer T, Antoine JC, Steck AJ. Clinical features and pathophysiological basis of sensory neuronopathies. Muscle Nerve 2004; 30: 255-68.
Graus F, Dalmau J, Reñe R, et al. Anti-Hu antibodies in patients with smallcell lung cancer. J Clin Oncol 1997; 15(8): 2866-72.
Graus F, Keime GF, Reñe R, et al. Anti-Hu- associated paraneoplastic encephalomyelitis:analysis of 200 patients. Brain 2001; 124:1138-48.
Graus F, Bonaventura I. Uchuya M,et al. Indolent anti-HU- associated paraneoplastic sensory neuropathy. Neurology 1994; 44: 2258-61.
Elrington GM, Murray NMF, Spiro SG, Newsom-Davis J. Neurological paraneoplastic syndromes in patients with small cell lung cáncer. A prospective survey of 150 patients. J Neurol Neurosurg Psychiatry 1991; 54: 764-7.
Darnell RB, Posner JB. Paraneoplastic Syndromes Involving The Nervous System. N Engl J Med 2003; 16: 1543-54.
Anderson NE, Rosenblumm MK, Graus F, et al. Autoantibodies in paraneoplastic syndromes associated with small-cell lung cancer. Neurology 1988; 38: 1391-8.
Graus F, Dalmau J, Valldeoriola F, et al. Immunological characterization of a neuronal antibody (anti-Tr) associated with paraneoplastic cerebellar degeneration and Hodgkin’s disease. J Neuroimmunol 1997; 74: 55-61.
Yagi Y, Inuzaka T, Takada K, et al. Changes in Anti-HuD Antibody Titers in the Long-Term course in paraneoplastic sensory neuropathy. Eur Neurol 1997; 37: 122-3.
Dalmau J. Furneaux HM, Gralla RJ, et al. Detection of the Anti-Hu Antibody in the serum of Patients with Small Cell Lung Cancer: A Quantitative Western Blot Analysis. Ann Neurol 1990; 27: 544-52.
Lladó A, Mannucci P, Capentier AF, et al. Value of HU antibody determinations in the follow-up of paraneoplastic neurologic syndromes. Neurology 2004; 63:1947-9.
Sghirlanzoni A, Pareyson D, Lauria G. Sensory neuron disease. Lancet Neurol 2005; 4: 349-61.
England JD, Asbury AK. Peripheral neuropathy. Lancet 2004; 363: 2151-61.
Stübgen P. Neuromuscular disorders in systemic malignancy and it’s treatment. Muscle Nerve 1995; 18: 636-48.
Plotkin SR, Wen PY. Neurologic Complications on Cancer Therapy. Neurol. Clin N Am 2003; 21: 279-318.
Graus F, Delaterre J Y, Antoine JC, et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes J Neurol Neurosutg Psychiatry 2004; 75: 1135-40.
Dropcho EJ. Remote Neurologic Manifestations of Cancer 2002; 20(1): 85-122.
Pascuzzi RM. Peripheral neuropathy. Med Clin N Am 2009; 93: 317-42.
Oki Y, Koike H, Iijima M, et al. Ataxic vs. painful form of paraneoplastic neuropathy. Neurology 2007; 69: 564-72.
Mauermann ML, Burns TM. Pearls and Oysters: Evaluation of peripheral neuropathies. Neurology 2009; 72: e28-e31.
Antoine JC, Mosnier JF, Absi L, et al. Carcinoma associated paraneoplastic peripheral neuropathies in patients with and without anti-onconeural ant bodies. J Neurol Neurosurg Psych 1999; 67: 7-14.
Rees JH, Hain SF, Johnson MR, et al. The role of [18F] fluoro-2 deoxyglucose- PET scanning in the diagnosis of paraneoplastic neurological disorders. Brain 2001; 2(11): 2223-31.
Sutton I. Paraneoplastic neurological syndromes. Curr Opin Neurol 2002; 15: 685-90.
Recht L, Mrugala M. Neurologic complications of hematologic neoplasms. Neurol Clin N Am 2003; 21: 87-105.
Rubio NE, Marey LJ, Torres CJO, et al. Miller-Fisher syndrome and Hodgkin´s disease. J Neurol Neurosurg Psychiatry 2002; 73: 343-50.
Sacco E, Pinto F, Sasso F, et al. Paraneoplastic syndromes in patients with urological malignancies. Urol Int 2009; 83: 1-11.
Minisini AM, Pauletto G, Bergonzi P, Fasola G. Paraneoplastic neurological syndromes and breast cancer. Breast Cancer Res Treat 2007; 105: 133-8.
Bladé J, Rosiñol L. Complications of Multiple Myeloma. Hematol Oncol Clin N Am 2007; 21: 1231-46.
Antoine JC, Honnorat J, Camdessanché JP, et al. Paraneoplastic Anti-CV2 Antibodies React with Peripheral Nerve and Are Associated with a Mixed Axonal and Demyelinating Peripheral Neuropathy. Ann Neurol 2001; 49(2): 214-21.
Yu Z, Kryzer TJ, Griesmann GE, et al. CRMP-5 Neuronal Autoantibody: Marker of Lung Cancer and Thymoma-Related Autoimmunity. Ann Neurol 2001; 49: 146-54.
Vernino S, Wolfe GI. Antibody testing in peripheral neuropathies. Neurol Clin 2007; 25: 29-46.
Somonelli M, Banna GL, Santoro A. Thymoma associated with myasthenia and autonomic anti-Hu paraneoplastic neuropathy- Tumori 2009; 95: 243-47.
Pleasure D. Keeping “Trk” of paraneoplastic syndromes. Arch Neurol 2005; 62: 1508-9.
McNamara B, Boniface SJ, Ray J, et al. Paraneoplastic sensory neuropathy and Purkinje cell antibodies. Muscle Nerve 1999; 22(10): 1466-7.
Voltz R. Can Antibodies in Serum Predict the Presence of Microscopic Tumors? Neurology 2007; 68: 887-8.
Tan KM, Lennon VA, Klein CJ, et al. Clinical spectrum of voltage-gated potassium channel autoimmunity. Neurology 2008; 70: 1883-90.
Pittock SJ, Lucchinetti CF, Parisi JE, et al. Amphipysin autoimmunity: paraneoplastic accompaniments. Ann Neurol 2005; 58: 96-107.
Oh SJ, Slaughter R, Harrell L. Paraneoplastic vasculitic neuropathy: a treatable neuropathy. Muscle Nerve 1991; 14: 152-6.
Bataller L, Dalmau J. Paraneoplastic disorders of the nervous system. Continuum lifelong learning in neurology 2005; 11: 69-92.
Pastores SM, Voigt LP. Acute respiratory failure in patients with cancer: diagnostic and management strategies. Crit Care Clin 2010; 26: 21-40.
Lambert EH, Eaton LM, Rooke ED. Defect of neuromuscular transmission associated with malignant neoplasm. Am J Physiol 1956; 187: 612–21.
Newsom-Davis J. Therapy in myasthenia gravis and Lambert-Eaton myasthenic syndrome. Semin Neurol 2003; 23(2): 191-8.
Benarroch EE. Neuronal voltage-gated calcium channels. Neurology 2010; 74: 1310-5.
Mason WP, Graus F, Lang B, et al. Small Cell lung cancer, paraneoplastic cerebellar degeneration and the Lambert-Eaton myasthenic syndrome. Brain 1997; 120: 1279-300.
Kleopa KA, Elman LB, Lang B, et al. Neuromyotonya and limbic encephalitis sera target mature Shaker-type K channels: subunit specificity correlates with clinical man festations. Brain 2006; 129: 1570-84.
Leonovicz BM, Gordon EA, Wass T. Paraneoplastic syndromes associated with lung cancer. Anesth Analg 2001; 93: 1557-9.
Graus F, Lang B, Pozo RP, et al. P/Q Type calcium-channel antibodies in paraneoplastic cerebellar degeneration with lung cancer. Neurology 2002; 59: 764-6.
O’ Neill, Murray NMF,Newsom DJ. The Lambert-Eaton Myasthenic Syndrome: A Review of 50 cases. Brain 1988; 111: 577-96.
Sabater L, Titulaer M, Saiz A, et al. SOX1 antibodies are markers of paraneoplastic Lambert-Eaton myasthenic syndrome. Neurology 2008; 70: 924-8.
Wirtz PW, Smallegange TM, Wintzen AR, Verschuuren JJ. Differences in clinical features between the Lambert-Eaton myasthenic syndrome with and without cancer: an analysis of 227 published cases Clin Neurol Neurosurg 2002; 104: 359-63.
Lang B, Evoli A. SOX1 auto-antibodies. Neurology 2008; 70: 906-7.
Wirtz PW, Sotodeh M, Nijnuis M, et al. D fference in distribution of muscle weakness between myasthenia gravis and the Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry 2002; 73: 766-8.
Chaudhry V, Watson DF, Bird SJ, Cornblath DR. Stimulated single-fiber electromyography in Lambert-Eaton myasthenic syndrome. Muscle Nerve 1991; 14: 1227-30.
Heinemann S, Zabel P, Hauber HP. Paraneoplastic Syndromes in lung cancer. Cancer Therapy 2008; 6: 687-98.
Eggers SDZ, Salomao DR, Dinapoli RP, Vernino S. Paraneoplastic and metastasic neurologic complications of Merckell cell carcinoma. Mayo Clin Proc 2001; 76: 327-30.
Farquhar C, Dickinson A, Bruce M. Prophylactic potential of pentosan polysulphate in transmissible spongiform encephalopathies. Lancet Neurol 1999; 353: 117-8.
Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol 2009; 8: 475-90.
Weigert C. Pathologisch-anatomischer Beiträg zur Erb ìschen Krankheit (myasthenia gravis). Neurologisches Zentralblatt 1901; 20: 597-601.
Mygland Ä, Vincent A, Newsom-Davis J, et al. Autoantibodies in thymomarelated myasthenia gravis with myositis or neuromyotonia. Arch Neurol 2000; 57: 527-31.
Kuks JBM, Oosterhuis HJGH Clinical presentation and epidemiology of myasthenia gravis in HJ Kaminski´s Myasthenia Gravis and related disorders. 1st Ed. Humana press; 2003, p. 93-114.
Lovelace RE, Younger DS. Myasthenia gravis with thymoma. Neurology 1997; 48: S76-81.
Tormoehlen LM, Pascuzzi RM. Thymoma, myasthenia gravis, and other paraneoplastic syndromes. Hematol Oncol Clin N Am 2008; 22: 509-26.
Hohfeld R, Dornmair K. Revisiting the immunopathogenesis of the inflammatory myopathies. Neurology 2007; 69: 1966-7.
Amato AA, Greenberg SA. Inflammatory myopathies. Continuum lifelong learning in neurology 2006; 12: 140-68.
Greenberg SA. Proposed immunologic models of the inflammatory myopathies and potential therapeutic implications. Neurology 2007; 69: 2008-19.
Airio AA, Pukkala E, Isomäki H. Elevated cancer incidence in patients with dermatomyositis: a population based study. J Rheumatol 1995; 22:1300-3.
Bohan A, Peter JB, Bowman RL, Pearson CM. A computer-assisted analysis of 153 patients with polimyositis and dermatomyositis. Medicine 1977; 56: 255-86.
Buchbinder R, Forbes A, Hall S, Dennet X, Giles G. Incidence of malignant disease in biopsy proven inflammatory myopathy. Ann Intern Med 2001; 134: 1087-95.
Callen JP. Myositis and malignancy. Curr Opin Rheumatol 1994; 6: 590-4.
Hill C, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A, Evans SR. Frequency of specific cancer types in dermatomyositis and polymyositis: a population based study. Lancet 2001; 357: 96-100.
Manchul LE, Pritchard KJ, Tenebaum J, Boyd NF, Lee P, Germanson T, Gordon DA. The frequency of malignant neoplasms in patients with polymyositis-dermatomyositis. Arch Intern Med 1985; 145: 1835-9.
Rachima C, Lengevitz P, Livneh A, Blumstein Z, Sadeh M, Bank I, gur H, Ehrenfeld M. High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis. Semin Arthritis Rheum 1998; 27: 319-24.
Sigurgeirson B, Lindelöf B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis–A population based study. NEJM 1992; 326: 363-7.
Stockton D, Doherty VR, Brewster DH. Risk of cancer in patients with dermatomyositis or polymyositis, and follow-up implications: a Scottish population-based cohort study. Br J of Cancer 2001; 85: 41-5.
Wakata N, Kurihara T, Saito E, Kinoshita M. Polymyositis and dermatomyositis associated with malignancy: a 30 year retrospective study. Int J Dermatol 2002; 41: 749-34.
Yazici Y, Kagen LJ. Clinical presentation of the idiopathic inflammatory myopathies. Rheum Dis Clin N Am 2002; 28: 823-32.
Zantos D, Zhang Y, Felson D. The overall and temporal association of cancer with polymyositis and dermatomyositis. J Rheumatol 1994; 21: 1855-9.
Peltier AC, Black BK, Raj SR, et al. Coexistent autoimmune autonomic ganglionopathy and myasthenia gravis associated with non-small cell lung cancer. Muscle Nerve 2010; 41: 416-9.
Vernino S, Freeman R. Peripheral autonomic neuropathies. Continuum Lifelong Learning in Neurology 2007; 13: 89-110.
Freeman R. Autonomic peripheral neuropathy. Neurol Clin 2007; 25: 277-301.
Sandroni P, Vernino S, Klein CM, et al. Idiopathic autonomic neuropathy. Arch Neurol 2004; 61: 44-8.
Vernino S, Sandroni P, Singer W, Low PA. Autonomic ganglia. Neurology 2008; 70: 1926-32.
Grubb BP. Neurocardiogenic syncope. N Eng J Med 2005; 352: 1004-10.
Jacob G, Costa F, Shannon JR, et al. The neuropathic postural tachycardia syndrome. N Eng J Med 2000; 343: 1008-14.
Wright GD, Mccullagh CD, Roberts SD. Digital necrosis with Ogilvie´s syndrome. Ann Rheum Dis 1997; 56: 224-5.
Benarroch EE. Enteric nervous system-functional organization and neurologic implications. Neurology 2007; 69:1953-7.
Vernino S, Low PA, Fealey RD, et al. Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. N Eng J Med 2000; 343: 847-55.
Matsui N, Mitsui T, Ohshima Y, et al. Anti-neuronal antibodies in acute pandysautonomia. Inter Med 2010; 49: 73-7.
Wildhaber B, Niggli F, Bergsträsser, et al. Paraneoplastic syndromes in ganglioneuroblastoma. Eur J Pediatr 2003; 162: 511-3.
Smith DS, Williams CS, Ferris CD. Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction. Gastroenterol Clin N Am 2003; 32: 619-58.
Jardine DL, Krediet CPT, Robinson BA. Barorreflex failure secondary to paraneoplastic encephalomyelitis in a 17 year old woman with neuroblastoma. J Neurol Neurosurg Psychiatry 2004; 75: 1645-52.
Kashyap P, Farrugia G. Enteric autoantibodies and gut motility disorders. Gastroenterol Clin N Am 2008; 37: 397-410.
Batke M, Cappell MS. Adynamic ileus and acute colonic pseudoobstruction. Med Clin N Am 2008; 92: 649-70.
Choi JS, Lim JS, Kim H, et al. Colonic pseudoobstruction: CT findings. AJR 2008; 190: 1521-6.
Catena F, Caira A, Ansaloni L, et al. Ogilvie´s syndrome treatment. Acta Bio Medica 2003; 74(2): 26-9.
Durai R. Colonic pseudoobstruction. Singapore Med J 2009; 50: 237-44.
Georgescu E, Vasile I, Ionescu R. Intestinal pseuoobstruction: an uncommon condition with heterogeneous etiology and unpredictable outcome. World J Gastroenterol 2008; 14: 954-9.
Kam MA. Intestinal pseudoobstruction. Gut 2000; 47: iv84.
Isaacs H. A syndrome of continuous muscle-fibre activity. J Neurol Neurosurg Psychiatry 1961; 24: 319-25.
Hart IK, Madison P, Newsom DJ, et al. Phenotypic variants of autoimmune peripheral nerve hyperexcitability. Brain 2002; 125:1887-95.
González G, Barros G, Russi ME, et al. Acquired neuromyotonia in childhood: a case report and review. Pediatr Neurol 2008; 38: 61-3.
Hayat GR, Ku kantrakorn K, Campbell WW, Guiliani MJ. Neuromyotonia: Autoimmune Pathogenesis and response to immune modularing therapy. J Neurol Sci 2000; 181: 38-43.
Newsom-Davis J, Mills KR. Immunological associations of acquired neuromyotonia (Isaac’s syndrome): Report of five cases and literature review. Brain 1993; 116: 453-69.
Ishii A, Hayashi A, Ohkoshi N, et al. Clinical evaluation of plasma exchange and high dose intravenous immunoglobulin in a patient with Isaacs´syndrome. J Neurol Neurosurg Psychiatry 1994; 57: 840-2.
Shillito P, Molenaar PC, Vincent A, et al. Acquired Neuromyotonia: evidence for autoantibodies directed against K+ channels of peripheral nerves. Ann Neurol 1995; 38: 714-22.
Pascual J, Sánchez PR, Berciano J, Calleja J. Paraneoplastic myotonia. Muscle Nerve 1994; 17: 694-5.
Cottrel DA, Blackmore KJ, Fawcett PRW, et al. Subacute presentation of Morvan´s syndrome after thymectomy. J Neurol Neurosurg Psychiatry 2004; 75: 1504-9.
Lee EK, Maselli RA, Ellis WG, et al. Morvan´s fibrillary chorea: a paraneoplastic manifestation of thymoma. J Neurol Neurosurg Psychiatry 1998; 65: 857-62.
Liguori R, Vincent A, Clover L, et al. Morvan´s syndrome: peripheral and central nervous system and cardiac involvement with antibodies to voltagegated potassium channels. Brain 2001; 124: 2417-26.
Spinazzi M, Argentiero V, Zuliani L, et al. Immunotherapy-revered compulsive monoaminergic, circadian rhythm disorder in Morvan syndrome. Neurology 2008; 71: 2008-10.
Lennon VA, Kryzer TJ, Griesmann GE, et al. Calcium-channel antibodies in the Lambert-Eaton syndrome and other paraneoplastic syndromes. N Eng J Med 1995; 332: 1467-74.
Molinuevo JL, Graus F, Serrando C. et al. Utility of Anti-Hu in the diagnosis of paraneoplastic sensory neuropathy. Ann Neurol 1998; 44: 976-80.