Significant improvement in paraneoplastic neurological syndromes without identifiable anti-neural antibodies in patients with breast cancer after breast surgery

Abstract

Paraneoplastic neurological syndromes (PNS) are neurological disorders that occur in close association with tumors without direct metastasis or invasion of the tumors and in which anti-neural antibodies may be present. Cerebellar ataxia is a common form of PNS in patients with breast cancer. However, reports of symptom improvement with breast cancer treatment are more common in patients with positive anti-neural antibodies and are rarely seen in those with negative anti-neural antibodies. In addition, there have been few quantitative evaluations of symptom improvement. We report a case in which neurological symptoms significantly improved after surgical treatment for breast cancer. The patient was a 78-years-old woman with subacute progressive cerebellar ataxia. A subsequent diagnosis of breast cancer led to the diagnosis of "PNS probable". A comprehensive search for anti-neural antibodies was negative in all cases. The quantitative index of the Scale for the Assessment and Rating of Ataxia (SARA) score, a standard evaluation method for ataxia in spinocerebellar degeneration, improved after breast cancer surgery. This case may provide a rationale for treating breast cancer patients negative for anti-neural antibodies, with the possibility of improving neurological symptoms.

Keywords: Breast cancer; Paraneoplastic neurological syndrome; Scale for the assessment and rating of ataxia score; Subacute cerebellar dysfunction.

Fig. 1

a–d 123 I-IMP cerebral perfusion single-photon emission computerized tomography imaging. Cerebellar hypoperfusion and mild hypoperfusion in the left cerebral hemisphere and frontal lobe predominantly are shown

Fig. 2

Change over time in total SARA score. Total SARA score gradually improved after IVIg and breast surgery. SARA, scale for the assessment and rating of ataxia; IVIg, intravenous immunoglobulin; POM, postoperative month