Cancer and motor neuron disease—causal or coincidental? Two contrasting cases

John Goodfellow, George Gorrie, Veronica Leach, Sameer Patel, Graham Mackay (Corresponding Author)

Research output: Contribution to journalArticle

Abstract

Introduction
Motor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not.

Case 1
A 61-year-old woman developed progressive walking difficulties over 9 months with weakness and stiffness in her legs. EMG showed fibrillations and positive sharp waves in multiple lower limb muscles bilaterally, with neurogenic units and a reduced recruitment pattern. An invasive ductal carcinoma of the breast was identified and she continued to deteriorate neurologically with worsening mobility, upper limb spasticity and fasciculations. She died approximately 26 months after symptom onset.

Case 2
A 57-year-old woman developed weight loss and weakness of her right arm without any sensory symptoms. At presentation, she had wasting and fasciculations in her right upper limb muscles, with normal reflexes, normal left upper limb and lower limb examination. Over the following week, she developed left upper limb weakness and fasciculations, brisk knee reflexes, and flexor plantar responses. Her EMG showed upper and lower limb denervation. She was found to have anti-Hu and anti-CV2 antibodies present in serum. A PET-CT showed active uptake in lymph nodes in the right hilum. Biopsy confirmed a small cell lung cancer. She had chemoradiation therapy and the tumour went into remission. She has remained well on follow-up 24 months later, regaining weight and strength after her chemotherapy. She continues to be monitored for cancer recurrence, but thus far appears to be in remission.

Conclusion
In cases with rapidly progressive MND, particularly of upper limb onset, consideration should be given to testing anti-neuronal antibodies and searching for an occult tumour.
Original languageEnglish
Pages (from-to)1461-1463
Number of pages3
JournalNeurological Sciences
Volume40
Issue number7
Early online date6 Mar 2019
DOIs
Publication statusPublished - Jul 2019

Fingerprint

Motor Neurons
Upper Extremity
Fasciculation
Lower Extremity
Neoplasms
Reflex
Anti-Idiotypic Antibodies
Mobility Limitation
Carcinoma, Ductal, Breast
Muscles
Small Cell Lung Carcinoma
Denervation
Weight Loss
Leg
Knee
Arm
Lymph Nodes
Biopsy
Neurons
Weights and Measures

Keywords

  • Motor neuron disease
  • Amyotrophic lateral sclerosis
  • Cancer
  • Paraneoplastic
  • Upper motor neurone signs
  • Lower motor neurone signs

Cite this

Cancer and motor neuron disease—causal or coincidental? Two contrasting cases. / Goodfellow, John ; Gorrie, George ; Leach, Veronica ; Patel, Sameer; Mackay, Graham (Corresponding Author).

In: Neurological Sciences, Vol. 40, No. 7, 07.2019, p. 1461-1463.

Research output: Contribution to journalArticle

Goodfellow, J, Gorrie, G, Leach, V, Patel, S & Mackay, G 2019, 'Cancer and motor neuron disease—causal or coincidental? Two contrasting cases', Neurological Sciences, vol. 40, no. 7, pp. 1461-1463. https://doi.org/10.1007/s10072-019-03784-9
Goodfellow, John ; Gorrie, George ; Leach, Veronica ; Patel, Sameer ; Mackay, Graham. / Cancer and motor neuron disease—causal or coincidental? Two contrasting cases. In: Neurological Sciences. 2019 ; Vol. 40, No. 7. pp. 1461-1463.
@article{02fcf152b1dc47bd8be11fa82a8ee318,
title = "Cancer and motor neuron disease—causal or coincidental? Two contrasting cases",
abstract = "IntroductionMotor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not.Case 1A 61-year-old woman developed progressive walking difficulties over 9 months with weakness and stiffness in her legs. EMG showed fibrillations and positive sharp waves in multiple lower limb muscles bilaterally, with neurogenic units and a reduced recruitment pattern. An invasive ductal carcinoma of the breast was identified and she continued to deteriorate neurologically with worsening mobility, upper limb spasticity and fasciculations. She died approximately 26 months after symptom onset.Case 2A 57-year-old woman developed weight loss and weakness of her right arm without any sensory symptoms. At presentation, she had wasting and fasciculations in her right upper limb muscles, with normal reflexes, normal left upper limb and lower limb examination. Over the following week, she developed left upper limb weakness and fasciculations, brisk knee reflexes, and flexor plantar responses. Her EMG showed upper and lower limb denervation. She was found to have anti-Hu and anti-CV2 antibodies present in serum. A PET-CT showed active uptake in lymph nodes in the right hilum. Biopsy confirmed a small cell lung cancer. She had chemoradiation therapy and the tumour went into remission. She has remained well on follow-up 24 months later, regaining weight and strength after her chemotherapy. She continues to be monitored for cancer recurrence, but thus far appears to be in remission.ConclusionIn cases with rapidly progressive MND, particularly of upper limb onset, consideration should be given to testing anti-neuronal antibodies and searching for an occult tumour.",
keywords = "Motor neuron disease, Amyotrophic lateral sclerosis, Cancer, Paraneoplastic, Upper motor neurone signs, Lower motor neurone signs",
author = "John Goodfellow and George Gorrie and Veronica Leach and Sameer Patel and Graham Mackay",
note = "GM has received NRS clinical research fellowship funding, providing some time to work on this publication. JG receives funding for his work in neuro-immunology for his post as a lecturer from Glasgow University.",
year = "2019",
month = "7",
doi = "10.1007/s10072-019-03784-9",
language = "English",
volume = "40",
pages = "1461--1463",
journal = "Neurological Sciences",
issn = "1590-1874",
publisher = "Springer-Verlag Italia",
number = "7",

}

TY - JOUR

T1 - Cancer and motor neuron disease—causal or coincidental? Two contrasting cases

AU - Goodfellow, John

AU - Gorrie, George

AU - Leach, Veronica

AU - Patel, Sameer

AU - Mackay, Graham

N1 - GM has received NRS clinical research fellowship funding, providing some time to work on this publication. JG receives funding for his work in neuro-immunology for his post as a lecturer from Glasgow University.

PY - 2019/7

Y1 - 2019/7

N2 - IntroductionMotor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not.Case 1A 61-year-old woman developed progressive walking difficulties over 9 months with weakness and stiffness in her legs. EMG showed fibrillations and positive sharp waves in multiple lower limb muscles bilaterally, with neurogenic units and a reduced recruitment pattern. An invasive ductal carcinoma of the breast was identified and she continued to deteriorate neurologically with worsening mobility, upper limb spasticity and fasciculations. She died approximately 26 months after symptom onset.Case 2A 57-year-old woman developed weight loss and weakness of her right arm without any sensory symptoms. At presentation, she had wasting and fasciculations in her right upper limb muscles, with normal reflexes, normal left upper limb and lower limb examination. Over the following week, she developed left upper limb weakness and fasciculations, brisk knee reflexes, and flexor plantar responses. Her EMG showed upper and lower limb denervation. She was found to have anti-Hu and anti-CV2 antibodies present in serum. A PET-CT showed active uptake in lymph nodes in the right hilum. Biopsy confirmed a small cell lung cancer. She had chemoradiation therapy and the tumour went into remission. She has remained well on follow-up 24 months later, regaining weight and strength after her chemotherapy. She continues to be monitored for cancer recurrence, but thus far appears to be in remission.ConclusionIn cases with rapidly progressive MND, particularly of upper limb onset, consideration should be given to testing anti-neuronal antibodies and searching for an occult tumour.

AB - IntroductionMotor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not.Case 1A 61-year-old woman developed progressive walking difficulties over 9 months with weakness and stiffness in her legs. EMG showed fibrillations and positive sharp waves in multiple lower limb muscles bilaterally, with neurogenic units and a reduced recruitment pattern. An invasive ductal carcinoma of the breast was identified and she continued to deteriorate neurologically with worsening mobility, upper limb spasticity and fasciculations. She died approximately 26 months after symptom onset.Case 2A 57-year-old woman developed weight loss and weakness of her right arm without any sensory symptoms. At presentation, she had wasting and fasciculations in her right upper limb muscles, with normal reflexes, normal left upper limb and lower limb examination. Over the following week, she developed left upper limb weakness and fasciculations, brisk knee reflexes, and flexor plantar responses. Her EMG showed upper and lower limb denervation. She was found to have anti-Hu and anti-CV2 antibodies present in serum. A PET-CT showed active uptake in lymph nodes in the right hilum. Biopsy confirmed a small cell lung cancer. She had chemoradiation therapy and the tumour went into remission. She has remained well on follow-up 24 months later, regaining weight and strength after her chemotherapy. She continues to be monitored for cancer recurrence, but thus far appears to be in remission.ConclusionIn cases with rapidly progressive MND, particularly of upper limb onset, consideration should be given to testing anti-neuronal antibodies and searching for an occult tumour.

KW - Motor neuron disease

KW - Amyotrophic lateral sclerosis

KW - Cancer

KW - Paraneoplastic

KW - Upper motor neurone signs

KW - Lower motor neurone signs

UR - http://www.mendeley.com/research/cancer-motor-neuron-diseasecausal-coincidental-two-contrasting-cases

U2 - 10.1007/s10072-019-03784-9

DO - 10.1007/s10072-019-03784-9

M3 - Article

VL - 40

SP - 1461

EP - 1463

JO - Neurological Sciences

JF - Neurological Sciences

SN - 1590-1874

IS - 7

ER -