Objective: To analyze the clinical spectrum, associated tumors, antibody profile, outcomes, and prognostic predictors in a cohort of paraneoplastiic movement disorders admitted in a tertiary care center.

Background: Paraneoplastic neurological syndromes (PNS) are immune-mediated disorders that occur as remote effects of malignancy and are not attributable to direct tumor invasion, metastasis, infection, or treatment-related toxicity. A These disorders frequently evolve subacutely and may precede the diagnosis of an underlying malignancy by weeks to months, thereby serving as a crucial neurological clue to occult cancer.

Method: This retrospective observational cohort study reviewed electronic medical records of patients evaluated at a tertiary care hospital in south India, between 2016 and 2024. Patients of any age diagnosed with definite, probable, or possible PMDs based on the PNS-Care Score and having a minimum follow-up of one year were included. Data on demographics, clinical phenotype, antibody profile, malignancy evaluation, neuroimaging, immunotherapy, tumor-directed treatment, and functional outcomes were extracted using a structured proforma. Functional outcomes were assessed using the modified Rankin Scale (mRS).

Results: A total of 30 patients with paraneoplastic movement disorders were identified. Cerebellar ataxia was the most common clinical phenotype(16,53.3%) followed by stiff-person spectrum disorders and opsoclonus–myoclonus syndrome. Among antibody-associated cases, anti-Yo antibodies were the most frequent(7,23.3%), followed by anti-GAD(4,13.3%) and anti-Ri antibodies(2,6.7%). Several patients had associated malignancies, most commonly breast and gynecological cancers. Patients received combinations of immunotherapy and tumor-directed treatment. Early recognition and treatment appeared to be associated with better functional outcomes(p<0.001).

Conclusion: Paraneoplastic movement disorders in this cohort most commonly presented with cerebellar ataxia and were frequently associated with onconeural antibodies and underlying malignancy. Early identification of antibody-associated syndromes and prompt oncological and immunological treatment may improve neurological outcomes.

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