Rehabilitation for a patient with anti-Yo antibody-positive paraneoplastic cerebellar degeneration caused by breast cancer

Abstract

Rationale:Rehabilitation for paraneoplastic cerebellar degeneration (PCD) has been indicated as necessary. However, there are only a few reports on rehabilitation in PCD. We describe the course of physical and cognitive functions and activities of daily living (ADL) in a patient with PCD and examine the effect of rehabilitation, along with a review of relevant literature.Patient concerns:A 42-year-old woman experienced rapid deterioration in cerebellar symptoms and was unable to walk. The cerebellar symptoms improved after mastectomy, which was performed 3 months after the onset of symptoms. However, the cerebellar symptoms exacerbated 11 months after the onset of symptoms. She underwent immunotherapy because the level of anti-Yo antibodies was high, and anti-glutamic acid decarboxylase antibodies were detected.Diagnoses:She was diagnosed with anti-Yo antibody-positive PCD caused by breast cancer.Interventions:Rehabilitation was performed preoperatively, postoperatively, and at 1 year after the onset of symptoms.Outcomes:Her physical function and ADL improved after the surgery and at 1 year after the onset of symptoms. Finally, she regained the ability to walk between parallel bars supported with one hand and a walking frame.Lessons:Given the results of this case and the relevant literature, it appears that rehabilitation improves physical function and ADL after oncotherapy. Particularly, initiating treatment within three months of onset of symptoms may enable patients to walk without assistance.

Gynecologic clear cell carcinoma and paraneoplastic cerebellar Degeneration: A literature review and case study

“…Interventions aimed at quality-of-life improvement for patients with PCD include pharmacotherapy and early rehabilitation during cancer treatment to improve physical function, especially with walking and completion of ADLs. ( Kato et al, 2017 ) Drug intervention focused on symptom control may assuage the lasting effects of PCD in this patient, specifically anti-convulsant barbiturates and beta blockers for residual tremor and muscle relaxants for limb spasticity. Early initiation of physical and occupational therapy for this patient may have contributed to her favorable recovery.…”

The early diagnoses and treatment of anti-Yo antibody-mediated paraneoplastic cerebellar degeneration in a patient with breast cancer: a case report

“…From this, we can hypothesize that HER2 overexpression is a risk factor for PCD, but the underlying mechanism requires further study. Oncology staging does not seem to be related to the occurrence of PCD since even a micro-invasive tumor can lead to PCD ( 9 ). Other clinical factors, including vascular cancer embolus and perineural invasion, have not been found to be related to the occurrence of PCD.…”

Paraneoplastic syndrome associated with gynaecological malignancy: a review of the evidence

“…Treatment options for PCD are limited to management of the underlying malignant cause, with surgical removal of the tumour load providing the most definitive treatment 8,11 . Multidisciplinary rehabilitation can restore physical function and the ability to carry out activities of daily living 12 . However, the prognosis of this group of patients remains poor; the median survival of patients with ovarian carcinoma and anti‐Yo antibody PCD is 22 months 8 …”

“…8,11 Multidisciplinary rehabilitation can restore physical function and the ability to carry out activities of daily living. 12 However, the prognosis of this group of patients remains poor; the median survival of patients with ovarian carcinoma and anti-Yo antibody PCD is 22 months. 8…”