Evolving Approaches to the Diagnosis and Management of Paraneoplastic Neurologic Syndromes: Ditte Primdahl, MD; Shailee Samir Shah, MD

WATCH TIME: 4 minutes

“We want to treat their underlying cancer, but we also want to treat their paraneoplastic syndrome. So, figuring out that perfect balance there is going to be key.”

Managing paraneoplastic neurologic syndromes (PNS) in the era of cancer immunotherapy can present unique challenges because of the interplay between oncologic treatments and immune-mediated neurological complications. In addition, immune checkpoint inhibitors (ICIs) have been increasingly linked to neurologic immune-related adverse events, including PNS.¹ The presence of specific autoantibodies have shown to significantly impact a patient’s responsiveness to immunotherapy and guide individualized treatment strategies.² As such, early recognition and timely initiation of immunosuppressive therapy may remain critical to minimizing long-term neurological damage.

These issues were explored in depth at the recently concluded 2025 American Academy of Neurology (AAN) Annual Meeting, held April 5-9, in San Diego, California. During a seminar on the core principles of brain tumors, experts Jennie W. Taylor, MD; Jasmin T. Jo, MD; and Akanksha Sharma, MD, reviewed current approaches to the management of adult gliomas. Their presentation covered updates in differential diagnosis, tumor classification, and key neurologic and oncologic treatment principles, as well as evolving strategies in supportive and palliative care. In addition, they highlighted new findings from recent clinical trials and emerging therapeutic breakthroughs in neuro-oncology.³

Building on these discussions, Feinberg School of Medicine neuro-oncology experts Ditte Primdahl, MD, assistant professor of neurology, and Shailee Samir Shah, MD, clinical assistant professor of neurology, spoke with NeurologyLive^® during the meeting to underscore the field’s growing understanding of PNS in the context of cancer immunotherapies. In the discussion. they emphasized the critical need for practical screening algorithms in community and nonacademic settings. The conversation highlighted the nuanced decision-making in managing cancer treatment when neurologic symptoms arise, emphasizing the need for interdisciplinary coordination in addressing these complex, overlapping conditions.

Click here for more coverage of AAN 2025.

REFERENCES
1. Graus F, Dalmau J. Paraneoplastic neurological syndromes in the era of immune-checkpoint inhibitors. Nat Rev Clin Oncol. 2019;16(9):535-548. doi:10.1038/s41571-019-0194-4
2. Binks S, Uy C, Honnorat J, Irani SR. Paraneoplastic neurological syndromes: a practical approach to diagnosis and management. Pract Neurol. 2022;22(1):19-31. doi:10.1136/practneurol-2021-003073
2. Taylor JW, Jo JT, Sharma A. Core Principles of Brain Tumors. Presented at: 2025 AAN Annual Meeting; April 5-9; San Diego, CA. C152.