Paraneoplastic syndrome

Diagnosis

Doctor ask for full medical history and perform a physical examination to see for any sign of paraneoplastic syndrome.

Clinical exam  

The neurologist will be examining the memory and mood as well as conducting a physical examination to evaluate for muscle tone or strength, reflexes, sense of touch, hearing, vision, coordination, and balance. This assessment will help evaluate your neurological response.

Laboratory tests  

The following laboratory tests may be required: 

• Blood tests. Used to detect the cause of symptoms such as antibodies that are commonly associated with this syndrome, infection, hormonal imbalance or metabolic disorders.
• Lumbar puncture (spinal tap). A needle will be inserted by the neurologist into the spinal cord to collect a sample of the cerebrospinal fluid (CSF) and analyze for any antibodies indicating immune disease related disorder. 

Imaging tests 

The following tests may be performed to detect a tumor or other cause which could cause problems in the nervous system. 

• Computerized Tomography (CT). Creates thin, cross–sectional images of the tissues using a special X–ray. 
• Magnetic Resonance Imaging (MRI). Views 3D images of the tissues using a magnetic field and radio waves.
• Positron Emission Tomography (PET). Detects any tumors, views the flow of the blood, measures tissue metabolism and checks for any discrepancies in the brain causing seizure. Creates 3D images of the body by injecting radioactive compounds into the body.
• PET plus CT. PET and CT Scans are combined for higher chance of finding smaller cancers which is mostly found in people with paraneoplastic neurological disorders.

Treatment  

Treatment involves curing cancer or targeting the immune response which causes the signs and symptoms of paraneoplastic syndromes. The treatment is based on the type of the disease which include:  

Medications

• Corticosteroids (e.g., prednisolone). Stops inflammation of the disease but on the other hand it can have serious side effects if used as a long term basis such as osteoporosis, type 2 diabetes, hypertension, increased cholesterol level, etc.
• Immunosuppressants (e.g., azathioprine, mycophenolate, rituximab and cyclophosphamide). Decreases the production of white blood cell counts that targets the disease. 
• Anti–seizure medications. Manages brain activities to control seizure related syndromes. 
• Medications to enhance nerve–to–muscle transmission (e.g., pyridostigmine).  Improves muscle function.

Other medical treatments

• Plasmapheresis. The procedure separates the plasma from the blood cells through a cell separator device. The device will extracted red and white blood cells then are put back to the body. The plasma part is thrown away because it contains unnecessary antibodies and injects other substitutes back instead. 
• Intravenous Immunoglobulin (IVIg). Fastens the elimination of unwanted antibodies by administering high doses of immunoglobulin that has healthier antibodies. 

Other therapies

If the paraneoplastic syndrome has caused disability, the following therapies may be undergone: 

• Physical therapy.  To strengthen muscle power and function on the damage muscles. 
• Speech therapy. Helpful for patients with speech or swallowing disorder in order to regain muscle control.