Autonomic nervous system involvement in autoimmune encephalitis and paraneoplastic neurological syndromes.
Rev Neurol (Paris)
; 180(1-2): 107-116, 2024.
Article
em En
| MEDLINE
| ID: mdl-38142198
ABSTRACT
In autoimmune neurological diseases, the autonomic nervous system can be the primary target of autoimmunity (e.g. autoimmune autonomic ganglionopathy), or, more frequently, be damaged together with other areas of the nervous system (e.g. Guillain-Barré syndrome). Patients with autoimmune encephalitis and paraneoplastic neurological syndromes (PNS) often develop dysautonomia; however, the frequency and spectrum of autonomic signs and symptoms remain ill defined except for those scenarios in which dysautonomia is a core feature of the disease. Such is the case of Lambert-Eaton myasthenic syndrome, Morvan syndrome or anti-NMDAR encephalitis; in the latter, patients with dysautonomia have been reported to carry a more severe disease and to retain higher disability than those without autonomic dysfunction. Likewise, the presence of autonomic involvement indicates a higher risk of death due to neurological cause in patients with anti-Hu PNS. However, in anti-Hu and other PNS, as well as in the context of immune checkpoint inhibitors' toxicities, the characterization of autonomic involvement is frequently overshadowed by the severity of other neurological symptoms and signs. When evaluated with tests specific for autonomic function, patients with autoimmune encephalitis or PNS usually show a more widespread autonomic involvement than clinically suggested, which may reflect a potential gap of care when it comes to diagnosing dysautonomia. This review aims to revise the autonomic involvement in patients with autoimmune encephalitis and PNS, using for that purpose an antibody-based approach. We also discuss and provide general recommendations for the evaluation and management of dysautonomia in these patients.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síndromes Paraneoplásicas
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Doenças do Sistema Nervoso Autônomo
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Doenças do Sistema Nervoso Periférico
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Síndromes Paraneoplásicas do Sistema Nervoso
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Doenças Autoimunes do Sistema Nervoso
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Encefalite
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Doença de Hashimoto
Limite:
Humans
Idioma:
En
Revista:
Rev Neurol (Paris)
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
França
País de publicação:
França