SÍNDROMES NEUROLÓGICAS PARANEOPLÁSICAS: UMA REVISÃO ATUALIZADA
DOI:
https://doi.org/10.61164/4nzvn072Keywords:
paraneoplastic neurological syndromes; neuronal autoantibodies; neuroimmunology; PNS-Care Score; immune checkpoint inhibitors.Abstract
Objetivo Síndromes neurológicas paraneoplásicas são um conjunto de distúrbios neurológicos secundários, surgindo por efeitos indiretos das neoplasias. Desde o reconhecimento das síndromes neurológicas paraneoplásicas houve grandes avanços na compreensão dos aspectos moleculares e clínicos desses distúrbios. Este trabalho objetiva traçar de forma panorâmica aspectos clínicos, fisiopatológicos, diagnósticos e terapêuticos dessas síndromes. Métodos Foi realizada uma revisão narrativa baseada em artigos originais, séries de casos, consensos diagnósticos e revisões sistemáticas publicados nas últimas décadas, com ênfase nos critérios revisados de 2021 para SNP e na literatura recente sobre neuroimunologia e toxicidades neurológicas associadas à imunoterapia oncológica. Resultados As SNP configuram distúrbios imunomediados resultantes da resposta antitumoral, frequentemente precedendo o diagnóstico da neoplasia. A identificação de anticorpos neuronais de alto ou intermediário risco é fundamental para estratificação diagnóstica e definição do risco de câncer. O sistema PNS-Care Score aprimora a classificação em níveis de certeza diagnóstica. As apresentações clínicas são heterogêneas, podendo envolver o sistema nervoso central, periférico ou autônomo. A interpretação dos testes de autoanticorpos exige cautela, dadas as armadilhas diagnósticas, incluindo falsos-positivos e incompatibilidades clínico-serológicas. Além disso, inibidores de checkpoint imunológico podem desencadear ou exacerbar apresentações semelhantes às SNP, exigindo avaliação clínica detalhada e abordagem terapêutica específica. Conclusão O reconhecimento precoce das SNP é crucial, uma vez que muitas vezes antecedem a detecção do tumor e possibilitam tratamento oncológico mais eficaz. A abordagem terapêutica inclui manejo da neoplasia, imunoterapia e controle sintomático, embora as evidências ainda sejam limitadas. A integração entre neurologia e oncologia é essencial para o manejo adequado desses pacientes.
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