| Abstract [eng] |
Objective: To analyze the neuropsychiatric aspects of paraneoplastic syndromes, with particular emphasis on autoimmune mechanisms, diagnostic approaches, and treatment options. Materials and Methods: A literature review and an analysis of clinical case series were conducted. The search for scientific publications was performed in the following electronic databases: MEDLINE (PubMed), NCBI, and Google Scholar. Sources were initially selected based on their titles and subsequently screened by reading the abstracts. The selected literature sources were analyzed, and a literature review was prepared based on these findings. Results: The pathogenesis of paraneoplastic neurological syndromes was found to be associated with an antitumor immune response directed against the nervous system. Nervous system damage may result either from a cell-mediated immune response targeting intracellular antigens or from a humoral immune response directed against cell-surface antigens. The clinical presentation of limbic encephalitis and anti-NMDA receptor encephalitis is characterized by a wide range of neuropsychiatric symptoms, including impairment of memory and other cognitive functions, seizures, behavioral and mood changes, psychotic symptoms, as well as disturbances of speech, sleep, and autonomic nervous system function. Analysis of case series showed that, in limbic encephalitis, neuropsychiatric symptoms often precede the diagnosis of the underlying tumor. In anti-NMDA receptor encephalitis, psychiatric symptoms typically predominate at disease onset, followed later by neurological manifestations and symptoms of autonomic dysfunction. It was also found that the most common reasons for delayed diagnosis of paraneoplastic neurological syndromes include a broad differential diagnosis, the nonspecific nature of symptoms, nonspecific test results, false-positive or false-negative antibody test results, and limitations of diagnostic criteria. The main principles of treatment include management of the primary tumor, administration of immunotherapy, and symptomatic treatment. Conclusions: Paraneoplastic neurological syndromes are rare and often underrecognized neurological disorders characterized by diverse and frequently nonspecific neuropsychiatric symptoms. Timely recognition of these syndromes, identification and treatment of the underlying tumor, and the use of immunotherapy are essential factors that may improve treatment outcomes and disease prognosis. |
