Current Oncology Reports

, 20:92 | Cite as

Updates in the Diagnosis and Treatment of Paraneoplastic Neurologic Syndromes

  • Ronnyson Susano Grativvol
  • Wagner Cid Palmeira Cavalcante
  • Luiz Henrique Martins Castro
  • Ricardo Nitrini
  • Mateus Mistieri SimabukuroEmail author
Neuro-oncology (S Nagpal, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Neuro-oncology


The disorders of the central nervous system associated with cancer by remote immune-mediated mechanisms are a heterogeneous group. These disorders encompass the classic paraneoplastic disorders and the recently recognized autoimmune encephalitis associated with antibodies against neuronal cell surface or synaptic proteins that occur with or without cancer association. In the last decade, the new surge of interest in neuronal diseases associated with anti-neuronal antibodies led to the rapid discovery of new forms of disease that have different manifestations and were not previously suspected to be immune mediated. The recognition of these syndromes is important because it may lead to early detection of an underlying malignancy and prompt initiation of treatment, improving chances for a better outcome.


Limbic encephalitis Onconeuronal antibodies Paraneoplastic neurological syndromes Paraneoplastic encephalomyelitis Paraneoplastic cerebellar degeneration Autoimmune encephalitis Stiff person syndrome Progressive encephalomyelitis with rigidity and myoclonus Opsoclonus-myoclonus syndrome Morvan syndrome Ophelia syndrome N-methyl-d-aspartate receptor (NMDAR) encephalitis Anti-AMPA receptor (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) encephalitis Anti-GABAbR (γ-aminobutyric acid receptor-B) encephalitis Anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis Anti-Caspr2 encephalitis (contactin-associated protein-like 2) Anti-glycine receptor (GlyR) antibodies Anti-mGluR5 (metabotropic glutamate receptor 5) Anti-mGLUR1 (metabotropic glutamate receptor 1)  Anti-Hu antibodies Anti-Ma2 antibodies Anti-DNER (Delta/Notch-like epidermal growth factor-related receptor) antibodies Anti-CV2/CRMP5 antibodies 


Compliance with Ethical Standards

Conflict of Interest

Ronnyson Susano Grativvol declares that he has no conflict of interest.

Wagner Cid Palmeira Cavalcante declares that he has no conflict of interest.

Luiz Henrique Martins Castro declares that he has no conflict of interest.

Ricardo Nitrini has received research funding from FAPESP, has served on advisory boards for Janssen-Cilag and Brazilian Nutricia, has received travel funding and reimbursement from Novartis, serves as an editor for Dementia & Neuropsychologia, serves on the editorial board for Alzheimer’s Disease & Associated Disorders and International Journal of Alzheimer’s Disease, and has served as a guest speaker for Novartis and Danone (Nutricia).

Mateus Mistieri Simabukuro declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lancaster E. Paraneoplastic disorders. Contin Minneap Minn. 2015;21(2 Neuro-oncology):452–75.Google Scholar
  2. 2.
    Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med. 2003;349(16):1543–54.CrossRefGoogle Scholar
  3. 3.
    Vedeler CA, Antoine JC, Giometto B, Graus F, Grisold W, Hart IK, et al. Management of paraneoplastic neurological syndromes: report of an EFNS Task Force. Eur J Neurol. 2006;13(7):682–90.CrossRefGoogle Scholar
  4. 4.
    Rosenfeld MR, Titulaer MJ, Dalmau J. Paraneoplastic syndromes and autoimmune encephalitis five new things. Neurol Clin Pract. 2012;2(3):215–23.CrossRefGoogle Scholar
  5. 5.
    Brain WR, Norris FH. The remote effects of cancer on the nervous system. New York: Grune and Stratton; 1965.Google Scholar
  6. 6.
    Dalmau J, Graus F. Paraneoplastic syndromes: from remote to clear and present knowledge. Brain. 2012;135(5):1650–553.CrossRefGoogle Scholar
  7. 7.
    Wilkinson PC, Zeromski J. Immunofluorescent detection of antibodies against Neurones in sensory carcinomatous neuropathy. Brain. 1965;88(3):529–38.CrossRefGoogle Scholar
  8. 8.
    Trotter JL, Hendin BA, Osterland CK. Cerebellar degeneration with Hodgkin disease: an immunological study. Arch Neurol. 1976;33(9):660–1.CrossRefGoogle Scholar
  9. 9.
    Corsellis JA, Goldberg GJ, Norton AR. “Limbic encephalitis” and its association with carcinoma. Brain J Neurol. 1968;91(3):481–96.CrossRefGoogle Scholar
  10. 10.
    Dalmau J, Furneaux HM, Rosenblum MK, Graus F, Posner JB. Detection of the anti-Hu antibody in specific regions of the nervous system and tumor from patients with paraneoplastic encephalomyelitis/sensory neuronopathy. Neurology. 1991;41(11):1757–64.CrossRefGoogle Scholar
  11. 11.
    Sillevis Smitt P, Manley G, Dalmau J, Posner J. The HuD paraneoplastic protein shares immunogenic regions between PEM/PSN patients and several strains and species of experimental animals. J Neuroimmunol. 1996;71(1–2):199–206.CrossRefGoogle Scholar
  12. 12.
    Voltz R, Dalmau J, Posner JB, Rosenfeld MR. T-cell receptor analysis in anti-Hu associated paraneoplastic encephalomyelitis. Neurology. 1998;51(4):1146–50.CrossRefGoogle Scholar
  13. 13.
    Pellkofer H, Schubart AS, Höftberger R, Schutze N, Pagany M, Schüller M, et al. Modelling paraneoplastic CNS disease: T-cells specific for the onconeuronal antigen PNMA1 mediate autoimmune encephalomyelitis in the rat. Brain. 2004;127(8):1822–30.CrossRefGoogle Scholar
  14. 14.
    Dalmau J, Tüzün E, Wu H, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1):25–36.CrossRefGoogle Scholar
  15. 15.
    Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu H, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol. 2009;65(4):424–34.CrossRefGoogle Scholar
  16. 16.
    Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, Raizer J, et al. Antibodies to the GABA B receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol. 2010;9(1):67–76.CrossRefGoogle Scholar
  17. 17.
    Lai M, Huijbers MG, Lancaster E, Graus F, Bataller L, Balice-Gordon R, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol. 2010;9(8):776–85.CrossRefGoogle Scholar
  18. 18.
    Irani SR, Alexander S, Waters P, Kleopa KA, Pettingill P, Zuliani L, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan’s syndrome and acquired neuromyotonia. Brain. 2010;133(9):2734–48.CrossRefGoogle Scholar
  19. 19.
    Lancaster E, Huijbers MGM, Bar V, Boronat A, Wong A, Martinez-Hernandez E, et al. Investigations of caspr2, an autoantigen of encephalitis and neuromyotonia. Ann Neurol. 2011;69(2):303–11.CrossRefGoogle Scholar
  20. 20.
    •• Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Ann N Y Acad Sci. 2015;1338:94–114. Outstanding review of the autoimmune encephalitis syndromes, clinical features, and immune associations CrossRefGoogle Scholar
  21. 21.
    Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 2005;58(4):594–604.CrossRefGoogle Scholar
  22. 22.
    Sabater L, Gaig C, Gelpi E, Bataller L, Lewerenz J, Torres-Vega E, et al. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study. Lancet Neurol. 2014;13(6):575–86.CrossRefGoogle Scholar
  23. 23.
    Dale RC, Irani SR, Brilot F, Pillai S, Webster R, Gill D, et al. N-methyl-D-aspartate receptor antibodies in pediatric dyskinetic encephalitis lethargica. Ann Neurol. 2009;66(5):704–9.CrossRefGoogle Scholar
  24. 24.
    Lancaster E, Dalmau J. Neuronal autoantigens—pathogenesis, associated disorders and antibody testing. Nat Rev Neurol. 2012;8(7):380–90.CrossRefGoogle Scholar
  25. 25.
    Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10(12):835–44.CrossRefGoogle Scholar
  26. 26.
    Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis. 2012;54(7):899–904.CrossRefGoogle Scholar
  27. 27.
    Granerod J, Cousens S, Davies NWS, Crowcroft NS, Sara L. Thomas. New estimates of incidence of encephalitis in England. Emerg Infect Dis. 2013;19(9):1455–62.CrossRefGoogle Scholar
  28. 28.
    Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J. Burden of encephalitis-associated hospitalizations in the United States, 1998–2010. Neurology. 2014;82(5):443–51.CrossRefGoogle Scholar
  29. 29.
    Graus F. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry. 2004;75(8):1135–40.CrossRefGoogle Scholar
  30. 30.
    Titulaer MJ, Soffietti R, Dalmau J, Gilhus NE, Giometto B, Graus F, et al. Screening for tumours in paraneoplastic syndromes: report of an EFNS Task Force: screening for tumours in PNS. Eur J Neurol. 2011;18(1):19–27.CrossRefGoogle Scholar
  31. 31.
    Honnorat J, Antoine J-C. Paraneoplastic neurological syndromes. Orphanet J Rare Dis. 2007;2:22.CrossRefGoogle Scholar
  32. 32.
    Simabukuro MM, Petit-Pedrol M, Castro LH, Nitrini R, Lucato L, Zambon AA, et al. GABAA receptor and LGI1 antibody encephalitis in a patient with thymoma. Neurol-Neuroimmunol Neuroinflammation. 2015;2(2):e73.CrossRefGoogle Scholar
  33. 33.
    Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79(11):1094–100.CrossRefGoogle Scholar
  34. 34.
    Giometto B, Grisold W, Vitaliani R, Graus F, Honnorat J, Bertolini G. Paraneoplastic neurologic syndrome in the PNS Euronetwork database: a European study from 20 centers. Arch Neurol. 2010;67(3):330–5.CrossRefGoogle Scholar
  35. 35.
    de Graaff E, Maat P, Hulsenboom E, van den Berg R, van den Bent M, Demmers J, et al. Identification of delta/notch-like epidermal growth factor-related receptor as the Tr antigen in paraneoplastic cerebellar degeneration. Ann Neurol. 2012;71(6):815–24.CrossRefGoogle Scholar
  36. 36.
    Rosenfeld MR, Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Contin Lifelong Learn Neurol. 2012;18(2, Neuro-oncology):366–83.CrossRefGoogle Scholar
  37. 37.
    •• Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15(4):391–404. A position letter based on literature review and gathered the experience of a team of experts with the aims of developing a practical, syndrome-based diagnostic approach to autoimmune encephalitis and providing guidelines to navigate through the differential diagnosis CrossRefGoogle Scholar
  38. 38.
    Gresa-Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014;13(2):1672177.CrossRefGoogle Scholar
  39. 39.
    Dalmau J. Clinical analysis of anti-Ma2-associated encephalitis. Brain. 2004 Jun 16;127(8):1831–1844.CrossRefGoogle Scholar
  40. 40.
    Dalmau J, Graus F, Rosenblum MK, Posner JB. Anti-Hu-associated paraneoplastic encephalomyelitis/sensory neuronopathy. A clinical study of 71 patients. Medicine (Baltimore). 1992;71(2):59–72.CrossRefGoogle Scholar
  41. 41.
    Graus F. Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients. Brain. 2001 Jun 1;124(6):1138–1348.CrossRefGoogle Scholar
  42. 42.
    Saiz A, Bruna J, Stourac P, Vigliani MC, Giometto B, Grisold W, et al. Anti-Hu-associated brainstem encephalitis. J Neurol Neurosurg Psychiatry. 2009 Apr;80(4):404–407.CrossRefGoogle Scholar
  43. 43.
    Honnorat J, Cartalat-Carel S, Ricard D, Camdessanche JP, Carpentier AF, Rogemond V, et al. Onco-neural antibodies and tumour type determine survival and neurological symptoms in paraneoplastic neurological syndromes with Hu or CV2/CRMP5 antibodies. J Neurol Neurosurg Psychiatry. 2009 Apr;80(4):412–416.CrossRefGoogle Scholar
  44. 44.
    Mason WP, Graus F, Lang B, Honnorat J, Delattre JY, Valldeoriola F, et al. Small-cell lung cancer, paraneoplastic cerebellar degeneration and the Lambert-Eaton myasthenic syndrome. Brain. 1997 Aug 1;120(8):1279–1300.CrossRefGoogle Scholar
  45. 45.
    Wirtz PW, Lang B, Graus F, van den Maagdenberg AMJM, Saiz A, Gans PA de K, et al. P/Q-type calcium channel antibodies, Lambert–Eaton myasthenic syndrome and survival in small cell lung cancer. J Neuroimmunol. 2005 Jul 1;164(1):161–165.CrossRefGoogle Scholar
  46. 46.
    Graus F, Lang B, Pozo-Rosich P, Saiz A, Casamitjana R, Vincent A. P/Q type calcium-channel antibodies in paraneoplastic cerebellar degeneration with lung cancer. Neurology. 2002 Sep 10;59(5):764–766.CrossRefGoogle Scholar
  47. 47.
    Sabater L, Höftberger R, Boronat A, Saiz A, Dalmau J, Graus F. Antibody Repertoire in Paraneoplastic Cerebellar Degeneration and Small Cell Lung Cancer. PLOS ONE. 2013 Mar 25;8(3):e60438.Google Scholar
  48. 48.
    Graus F, Ariño H, Dalmau J. Paraneoplastic neurological syndromes in Hodgkin and non-Hodgkin lymphomas. Blood. 2014;123:3230–3238.CrossRefGoogle Scholar
  49. 49.
    Smitt PS, Kinoshita A, De Leeuw B, Moll W, Coesmans M, Jaarsma D, et al. Paraneoplastic Cerebellar Ataxia Due to Autoantibodies against a Glutamate Receptor. N Engl J Med. 2000 Jan 6; 342(1):21–27.CrossRefGoogle Scholar
  50. 50.
    Marignier R, Chenevier F, Rogemond V, et al. Metabotropic glutamate receptor type 1 autoantibody–associated cerebellitis: A primary autoimmune disease? Arch Neurol. 2010 May 1;67(5):627–630.Google Scholar
  51. 51.
    Iorio R, Damato V, Mirabella M, Vita MG, Hulsenboom E, Plantone D, et al. Cerebellar degeneration associated with mGluR1 autoantibodies as a paraneoplastic manifestation of prostate adenocarcinoma. J Neuroimmunol. 2013 Oct 15;263(1–2):155–158.CrossRefGoogle Scholar
  52. 52.
    • Lopez-Chiriboga AS, Komorowski L, Kümpfel T, Probst C, Hinson SR, Pittock SJ, et al. Metabotropic glutamate receptor type 1 autoimmunity Clinical features and treatment outcomes. Neurology. 2016 Mar 15;86(11):1009–1013. It retrospectively describes the clinical associations of immunoglobulin G (IgG) targeting metabotropic glutamate receptor 1 (mGluR1-IgG). The largest series of patients with mGLUr1 ataxia.CrossRefGoogle Scholar
  53. 53.
    Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000 Jul 1;123(7):1481–1494.CrossRefGoogle Scholar
  54. 54.
    • van Sonderen A, Thijs RD, Coenders EC, Jiskoot LC, Sanchez E, de Bruijn MAAM, et al. Anti-LGI1 encephalitis: Clinical syndrome and long-term follow-up. Neurology. 2016 Oct 4;87(14):1449–1456. A nationwide study; a detailed description of the clinical features and long-term outcome of a LGI1 encephalitis. Google Scholar
  55. 55.
    • Ariño H, Armangué T, Petit-Pedrol M, Sabater L, Martinez-Hernandez E, Hara M, et al. Anti-LGI1–associated cognitive impairment Presentation and long-term outcome. Neurology. 2016 Aug 23;87(8):759–765. This paper determines the clinical presentation, long-term outcome, and LGI1 encephalitis evolution. CrossRefGoogle Scholar
  56. 56.
    van Sonderen A, Ariño H, Petit-Pedrol M, Leypoldt F, Körtvélyessy P, Wandinger K-P, et al. The clinical spectrum of Caspr2 antibody-associated disease. Neurology. 2016 Aug 2;87(5):521–528.Google Scholar
  57. 57.
    Höftberger R, Titulaer MJ, Sabater L, Dome B, Rózsás A, Hegedus B, et al. Encephalitis and GABAB receptor antibodies Novel findings in a new case series of 20 patients. Neurology. 2013;81(17):1500–1506.CrossRefGoogle Scholar
  58. 58.
    Höftberger R, van Sonderen A, Leypoldt F, Houghton D, Geschwind M, Gelfand J, et al. Encephalitis and AMPA receptor antibodies Novel findings in a case series of 22 patients. Neurology. 2015 Jun 16;84(24):2403–2412.CrossRefGoogle Scholar
  59. 59.
    Caviness JN, Forsyth PA, Layton DD, McPhee TJ. The movement disorder of adult opsoclonus. Mov Disord Off J Mov Disord Soc. 1995 Jan;10(1):22–27.CrossRefGoogle Scholar
  60. 60.
    Klaas JP, Ahlskog J, Pittock SJ, et al. Adult-onset opsoclonus-myoclonus syndrome. Arch Neurol. 2012 Dec 1;69(12):1598–1607.CrossRefGoogle Scholar
  61. 61.
    Kinsbourne M. Myoclonic encephalopathy of infants. J Neurol Neurosurg Psychiatry. 1962 Aug;25(3):271–276.CrossRefGoogle Scholar
  62. 62.
    Sahu JK, Prasad K. The opsoclonus–myoclonus syndrome. Pract Neurol. 2011 Jun 1;11(3):160–166.CrossRefGoogle Scholar
  63. 63.
    • Armangué T, Sabater L, Torres-Vega E, Martínez-Hernández E, Ariño H, Petit-Pedrol M, et al. Clinical and Immunological Features of Opsoclonus-Myoclonus Syndrome in the Era of Neuronal Cell Surface Antibodies. JAMA Neurol. 2016 Apr;73(4):417–424. Report of the clinical and immunological features of idiopathic OMS (I-OMS) andparaneoplastic OMS (P-OMS), the occurrence of antibodies to cell surface antigens, and the discovery of a novel cell surface epitope.CrossRefGoogle Scholar
  64. 64.
    Bataller L, Graus F, Saiz A, Vilchez JJ, Spanish Opsoclonus-Myoclonus Study Group. Clinical outcome in adult onset idiopathic or paraneoplastic opsoclonus-myoclonus. Brain J Neurol. 2001 Feb;124(Pt 2):437–443.Google Scholar
  65. 65.
    Dalakas MC. Stiff person syndrome: advances in pathogenesis and therapeutic interventions. Curr Treat Options Neurol. 2009;11(2):102–110.CrossRefGoogle Scholar
  66. 66.
    Saiz A, Blanco Y, Sabater L, González F, Bataller L, Casamitjana R, et al. Spectrum of neurological syndromes associated with glutamic acid decarboxylase antibodies: diagnostic clues for this association. Brain. 2008 Oct 1;131(10):2553–2263.CrossRefGoogle Scholar
  67. 67.
    Murinson BB, Guarnaccia JB. Stiff-person syndrome with amphiphysin antibodies Distinctive features of a rare disease. Neurology. 2008;71(24):1955–1958.CrossRefGoogle Scholar
  68. 68.
    Whiteley AM, Swash M, Urich H. Progressive encephalomyelitis with rigidity. Brain J Neurol. 1976 Mar;99(1):27–42.CrossRefGoogle Scholar
  69. 69.
    Carvajal-González A, Leite MI, Waters P, Woodhall M, Coutinho E, Balint B, et al. Glycine receptor antibodies in PERM and related syndromes: characteristics, clinical features and outcomes. Brain. 2014 Aug Google Scholar
  70. 70.
    Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011 Jan;10(1):63–74.CrossRefGoogle Scholar
  71. 71.
    Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush A unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79(11):1094–1100.CrossRefGoogle Scholar
  72. 72.
    Petit-Pedrol M, Armangue T, Peng X, Bataller L, Cellucci T, Davis R, et al. Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: a case series, characterisation of the antigen, and analysis of the effects of antibodies. Lancet Neurol. 2014;13(3):276–86.CrossRefGoogle Scholar
  73. 73.
    • Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort . Lancet Neurol. 2013;12(2):157–65. The largest cohort of patients. It assesses the presentation of the disease, the spectrum of symptoms, immunotherapies used, timing of improvement, and long-term outcome.Google Scholar
  74. 74.
    Lancaster E, Martinez-Hernandez E, Titulaer MJ, Boulos M, Weaver S, Antoine J-C, et al. Antibodies to metabotropic glutamate receptor 5 in the Ophelia syndrome. Neurology. 2011;77(18):1698–16701.CrossRefGoogle Scholar
  75. 75.
    Mathew RM, Vandenberghe R, Garcia-Merino A, Yamamoto T, Landolfi JC, Rosenfeld MR, et al. Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis. Neurology. 2007 Mar 20;68(12):900–905.CrossRefGoogle Scholar
  76. 76.
    •• Dalmau J, Graus F. Antibody-Mediated Encephalitis. Ropper AH, editor. N Engl J Med. 2018 Mar;378(9):840–851. Outstanding review of the autoimmune encephalitis syndromes Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ronnyson Susano Grativvol
    • 1
  • Wagner Cid Palmeira Cavalcante
    • 1
  • Luiz Henrique Martins Castro
    • 1
  • Ricardo Nitrini
    • 1
  • Mateus Mistieri Simabukuro
    • 1
    • 2
    Email author
  1. 1.Neurology Division, Hospital das ClínicasUniversity of São Paulo School of MedicineSao PauloBrazil
  2. 2.The State of São Paulo Cancer InstituteSao PauloBrazil

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