Ask the Expert 1402. Paraneoplastic Diseases and Rare Neuroimmune Disorders

In this SRNA “Ask the Expert” episode, Krissy Dilger of SRNA spoke with neuroimmunologist Dr. Shailee Shah about paraneoplastic neurologic syndromes—immune-mediated, “off-target” effects of cancer that can affect the brain, spinal cord, or peripheral nerves. Dr. Shah described updated diagnostic criteria and scoring that combine neurologic phenotypes, cancer risk, and high-risk autoantibodies, and she explained how immune checkpoint inhibitors can trigger immune-related neurologic adverse events that don’t always fit classic rules [00:01:48]. She reviewed how these syndromes differ from other autoimmune neurologic disorders and outlined common subacute presentations such as limbic encephalitis, brainstem encephalitis, cerebellar ataxia, seizures, and neuropathies [00:08:09]. Dr. Shah emphasized prompt evaluation with neurologic exam, MRI/EEG/EMG as appropriate, blood and CSF antibody testing, cancer screening, and coordinated oncologic and immunosuppressive treatment to prevent worsening disability [00:17:24].Shailee Shah, MD is a Clinical Assistant Professor in the Neuroimmunology Division with Northwestern Medicine and Northwestern University. She is an autoimmune neurologist with expertise in the management of paraneoplastic and autoimmune neurological diseases. She also treats rare neuroimmunological diseases such as neuromyelitis optica and MOG associated disease. She is co-director of the Northwestern Medicine Paraneoplastic Neurological Disease Clinic.00:00 Welcome and Guest Intro00:58 What Is Paraneoplastic01:48 New Criteria and Antibodies04:59 Diagnostic Challenges and ICI08:09 Paraneoplastic vs Autoimmune10:22 How Common Are They13:03 Early Symptoms to Watch17:24 When to Seek Care19:09 Testing and Workup24:20 Paraneoplastic Myelitis27:55 Delays and Specialty Centers31:38 Cancer Link and Treatment37:16 Changing Therapies38:19 Recovery and Prognosis39:58 Patient Advice and Hope42:52 Closing