Importance of clinical observations

Clinical case reports can be powerful and informative; they can suggest novel hypotheses, identify gaps of knowledge, and provide suggestions for improvement. In this issue of Neurology® Neuroimmunology & Neuroinflammation, Hottinger et al.1 report a fascinating case with interesting implications. The authors describe a 71-year-old woman with metastatic small-cell lung cancer (SCLC) who developed anti-Hu–associated paraneoplastic encephalitis 4 days after receiving treatment with immune checkpoint inhibitors (nivolumab and ipilimumab). Considering that this disorder is mediated by cytotoxic T cells against a family of onconeuronal antigens (Hu proteins), the authors reasoned that natalizumab would block the migration of onconeuronal-specific T cells across the blood-brain barrier preventing neuronal damage, while not affecting T-cell activity against the systemic cancer. Indeed, after treatment with natalizumab, the patient showed substantial improvement of the neurologic disorder as well as a durable oncologic response. In addition to several interesting points raised by the authors, the case is remarkable for the following reasons: (1) it strongly supports the concept that anti-Hu–associated paraneoplastic symptoms are predominantly mediated by cytotoxic T-cell mechanisms. Although this syndrome develops in association with antibodies that are excellent biomarkers of the paraneoplastic disorder, the underlying (and still not well understood) mechanisms a...

Source: Neurology Neuroimmunology and Neuroinflammation - February 2, 2018 Category: Neurology Authors: Dalmau, J. Tags: Editor ' s Corner Source Type: research