title: Narcolepsy, REM sleep behavior disorder, and supranuclear gaze palsy associated with Ma1 and Ma2 antibodies and tonsillar carcinoma.
abstract: OBJECTIVE
  To describe a patient with diencephalic and mesencephalic presentation of a Ma1 and Ma2 antibody-associated paraneoplastic neurological disorder.
  
  
  METHODS
  Case report.
  
  
  METHODS
  The Colorado Neurological Institute Movement Disorders Center in Englewood, Colorado, and the Mayo Clinic in Rochester, Minnesota.
  
  
  METHODS
  A 55-year-old man with a paraneoplastic neurological disorder characterized by rapid eye movement sleep behavior disorder, narcolepsy, and a progressive supranuclear palsy-like syndrome in the setting of tonsillar carcinoma.
  
  
  METHODS
  Immunotherapy for paraneoplastic neurological disorder, surgery and radiotherapy for cancer, and symptomatic treatment for parkinsonism and sleep disorders.
  
  
  METHODS
  Polysomnography, multiple sleep latency test, and neurological examination.
  
  
  RESULTS
  The cancer was detected at a limited stage and treatable. After oncological therapy and immunotherapy, symptoms stabilized. Treatment with modafinil improved daytime somnolence.
  
  
  CONCLUSIONS
  Rapid onset and progression of multifocal deficits may be a clue to paraneoplastic etiology. Early treatment of a limited stage cancer (with or without immunotherapy) may possibly slow progression of neurological symptoms. Symptomatic treatment may be beneficial.
authors.affiliation: Colorado Neurological Institute Movement Disorders Center, Englewood, CO 80113, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Adams
authors.forename: Andrew
authors.initials: A
authors.lastname: McKeon
authors.forename: Michael H
authors.initials: MH
authors.lastname: Silber
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000941:Antigens / Q000276:immunology*; D000951:Antigens, Neoplasm / Q000276:immunology*; D001323:Autoantibodies / Q000096:biosynthesis; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D009419:Nerve Tissue Proteins / Q000276:immunology*; D015835:Ocular Motility Disorders / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D020364:Paraneoplastic Polyneuropathy / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013494:Supranuclear Palsy, Progressive / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D014067:Tonsillar Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000276:immunology
chemical_list: D000941:Antigens; D000951:Antigens, Neoplasm; D001323:Autoantibodies; C117985:Ma1 antigen; C119249:Ma2 antigen; D009419:Nerve Tissue Proteins