Ministerul Sănătăţii Anexă din 16/09/2010 Intrare In Vigoare

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ANEXA Nr. 4
Managementul sindroamelor neurologice paraneoplazice:
raportul grupului de lucru EFNS
C.A. Vedeler^a,b, J.C. Antoine^c, B. Giometto^d, F. Graus^e, W. Grisold^f, I.K. Hart^g, J. Honnorat^h, P.A.E. Sillevis
Smitt^i, J.J.G.M. Verschuuren^j and R. Volz^k pentru Paraneoplastic Neurological Syndrome Euronetwork
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^a Department of Neurology, Haukeland University Hospital, Bergen, Norway;
^b Department of Clinical Medicine, University of Bergen, Bergen, Norway;
^c Department of Neurology, Hopital Bellevue, Saint Etienne, France;
^d Department of Neurology and Psychiatry (2Neurologic Clinic) University of Padua, Padua, Italy;
^e Service of Neurology, Institut d'Investigacio Biomedica August Pi i Sunyer (IDIBAPS), Hospital
Clinic, University of Barcelona, Barcelona, Spain;
^f Ludwig Boltzmann Institut fur Neuroonkologie, Vienna, Linz, Austria;
^g Neuroimmunology Group, Department of Neurological Science, Liverpool, UK;
^h Ataxia Research Center, Neurology B, Hospital Neurologique, Lyon, France;
^i Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands;
^j Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; and
^k Department of Palliative Medicine, University of Cologne, Cologne, Germany
Cuvinte cheie: cancer, investigaţie, neurologie, paraneoplazic, tratament
Sindroamele neurologice paraneoplazice (PNS) reprezintă efectele la distanţă ale cancerului asupra sistemului
nervos. Prezentul raport reprezintă o prezentare generală a managementului PNS clasice ca encefalită limbică
paraneoplazică, neuronopatia senzorială subacută, degenerescenţa cerebeloasă paraneoplazică, mioclonusul,
opsoclonusul paraneoplazic, sindromul miastenic Lambert-Eaton şi hiperexcitabilitatea nervoasă periferică
paraneoplazică. Miastenia gravis şi neuropatiile paraproteinemice nu sunt incluse în acest raport. Nu au fost posibile
recomandări bazate pe dovezi dar s-a ajuns la un consens privind reguli de bună practică medicală. Sunt indicate
investigaţiile urgente, în special în sindroamele ce afectează sistemul nervos central, astfel încât să poată fi posibil un
tratament cât mai precoce al tumorii şi să poată fi prevenite distrucţia neuronală progresivă şi deficitele neurologice
ireversibile. Anticorpii onconeuronali sunt de mare importanţă în investigarea PNS şi sunt utili în depistarea tumorii
subiacente. PDG-PET este folositoare atunci când screening-ul radiologic tumoral iniţial a fost negativ. Detecţia şi
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