Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ann N Y Acad Sci. 2011 Sep;1233(1):279-84. doi: 10.1111/j.1749-6632.2011.06113.x.
Paraneoplastic syndromes affecting the brainstem and cerebellum are reported to cause a variety of abnormalities of eye movements. Recent studies have begun to account for the mechanisms underlying several syndromes, characterized by opsoclonus, slow, or dysmetric saccades, as well as downbeat nystagmus. We provide evidence that upbeat nystagmus in a female patient with pancreatic cancer reflected a cerebellar-induced imbalance of otolithic pathways: she showed marked retropulsion, and her nystagmus was dependent on head position, being absent when supine, and suppressed with convergence. In addition to anti-Hu antibodies, we demonstrated antibodies to a novel neuronal cell surface antigen. Taken with other recent studies, our findings suggest that paraneoplastic syndromes arise due to antibodies against surface neuronal antigens, including receptors and channels. Abnormal eye movements in paraneoplastic syndromes offer insights into the pathogenesis of these disorders and the opportunity to test potential therapies, such as new drugs with effects on neuronal channels.
据报道，影响脑桥和小脑的副肿瘤综合征可引起多种眼球运动异常。最近的研究开始解释几种综合征的潜在机制，这些综合征的特征是眼球震颤、缓慢或不协调的扫视，以及下跳性眼球震颤。我们提供的证据表明，患有胰腺癌的女性患者的上扬性眼球震颤反映了耳石通路的小脑诱导失衡：她表现出明显的后退，并且她的眼球震颤取决于头部位置，仰卧时消失，并且在集合时被抑制。除了抗 Hu 抗体外，我们还证明了针对新型神经元细胞表面抗原的抗体。结合其他最近的研究，我们的发现表明，副肿瘤综合征是由于针对表面神经元抗原的抗体引起的，包括受体和通道。副肿瘤综合征中的异常眼球运动为这些疾病的发病机制提供了深入了解，并为测试潜在的治疗方法提供了机会，例如针对神经元通道的新型药物。
