「ホスピス徳島」における末期癌患者の傍腫瘍性神経症候群の発症頻度とその臨床的意義

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  • ホスピス トクシマ ニオケル マッキ ガン カンジャ ノ ボウシュヨウセイ シンケイ ショウコウグン ノ ハッショウ ヒンド ト ソノ リンショウテキ イギ
  • 第12回徳島医学会賞受賞論文 「ホスピス徳島」における末期癌患者の傍腫瘍性神経症候群の発症頻度とその臨床的意義
  • Neurological syndrome of advanced cancer patients in Hospice Tokushima

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Neurological complications in advanced cancer occur frequently and therefore an adequate neurological assessment must always be part of patient evaluation in hospice palliative care. Paraneoplastic neurological syndromes are rare, probably affecting less than 1 per cent of patients with cancer, even if the most commonly associated neoplasms, such as small-cell lung cancer and ovarian cancer are considered. Neurological complications were studied in 127 inpatients with advanced cancers. Neurological complications were seen in up to 40 per cent of the patients. The most frequent symptom was derilium, followed in order to lethargy, paraplegia, depression, dementia, hemiplegia, restlessness, aphasia, stupor, facial palsy, recurrent laryngeal nerve palsy, convulsion, and myastenia. Those symptoms were seen in patients in hepatic encephalitis（12）, metastatic brain tumor（9）, metastatic spinal cord injury（8）, depression（4）, paraneoplastic syndrome（4）, hypercalcemia（2）, senile dementia（2）, peripheral neuritis（2）, and cerebral infarction（2）. Of the four patients with paraneoplastic syndrome, one patient had both anti-Hu antibody and anti-VGCC antibody and two patients had anti-neuronal nuclear antibodies. These results indicate that paraneoplastic neurological syndromes are associated more than 1 per cent of patients with advanced cancer.

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