title: Delayed onset of a second paraneoplastic neurological syndrome in eight patients.
abstract: BACKGROUND
  The occurrence of a second delayed paraneoplastic neurological syndrome (PNS), different from the first, in the same patient, is not well known. However, recognition of this possibility is important in the management of the patient with PNS.
  
  
  OBJECTIVE
  To describe eight patients who presented with two different PNS with a time delay of months to years.
  
  
  METHODS
  Retrospective analysis of eight patients, included in the European PNS database, with two different PNS that occurred months to years apart.
  
  
  RESULTS
  The median delay between the two different PNS was 15 months. The antibody repertoire did not change between the two episodes. Anti-Hu was detected in five patients, and anti-CV2 and anti-Ri in one each. One patient did not present onconeural antibodies. Lung cancer was diagnosed in six patients. In five patients, the second PNS revealed a cancer relapse (n=4) or a second cancer (n=1) and in three it occurred without evidence of tumour recurrence. In these three patients, all with anti-Hu antibodies, the second episode consisted of a lower motor neuron disease. Median survival was not reached after a median follow-up of 5 years.
  
  
  CONCLUSIONS
  A second PNS can reveal a cancer relapse but can also arise in its absence. The long survival of patients with a second PNS suggests that the immune response might be more effective in controlling the cancer.
authors.affiliation: Hospices Civils de Lyon, Hôpital Neurologique, Centre de Référence Maladie Rare Syndromes Neurologiques Paranéoplasiques, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Ducray
authors.forename: Francesc
authors.initials: F
authors.lastname: Graus
authors.forename: Maria Claudia
authors.initials: MC
authors.lastname: Vigliani
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Antoine
authors.forename: Veronique
authors.initials: V
authors.lastname: Rogemond
authors.forename: Albert
authors.initials: A
authors.lastname: Saiz
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015153:Blotting, Western; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007150:Immunohistochemistry; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000276:immunology / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D020361:Paraneoplastic Syndromes, Nervous System / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D012189:Retrospective Studies; D013030:Spain; D013256:Steroids / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D013256:Steroids