Opsoclonus myoclonus syndrome

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Opsoclonus myoclonus syndrome
Other namesDancing eye syndrome [1]
Specialty Neurology   OOjs UI icon edit-ltr-progressive.svg

Opsoclonus myoclonus syndrome (OMS), also known as opsoclonus-myoclonus-ataxia (OMA), is a rare neurological disorder of unknown cause which appears to be the result of an autoimmune process involving the nervous system. It is an extremely rare condition, affecting as few as 1 in 10,000,000 people per year. It affects 2 to 3% of children with neuroblastoma and has been reported to occur with celiac disease and diseases of neurologic and autonomic dysfunction. [2] [3]

Contents

Signs and symptoms

Symptoms include:[ citation needed ]

About half of all OMS cases occur in association with neuroblastoma (a cancer of the sympathetic nervous system usually occurring in infants and children). [8]

Disease course and clinical subtypes

In most cases, OMS starts with an acute flare-up of physical symptoms within days or weeks, but some less obvious symptoms such as irritability and malaise may begin weeks or months earlier.[ citation needed ]

Cause

In children, most cases are associated with neuroblastoma and most of the others are suspected to be associated with a low-grade neuroblastoma that spontaneously regressed before detection. In adults, most cases are associated with breast carcinoma or small-cell lung carcinoma. [9] It is one of the few paraneoplastic (meaning 'indirectly caused by cancer') syndromes that occurs in both children and adults, although the mechanism of immune dysfunction underlying the adult syndrome is probably quite different.[ citation needed ]

It is hypothesized that a viral infection (perhaps St. Louis encephalitis, Chikungunya, Epstein-Barr, Coxsackie B, enterovirus, or just a flu) causes the remaining cases, though a direct connection has not been proven. [10] Rare cases of Opsoclonus myoclonus syndrome associated with Lyme disease have also been reported. [11]

OMS is not generally considered an infectious disease. OMS is not passed on genetically.[ citation needed ]

Diagnosis

Because OMS is so rare and occurs at an average age of 19 months (6 to 36 months), a diagnosis can be slow. Some cases have been diagnosed as having been caused by a virus. After a diagnosis of OMS is made, an associated neuroblastoma is discovered in half of cases, with median delay of 3 months. [12]

The interictal EEG pattern is usually normal. [13]

Treatment

There is no known definitive cure for OMS. However, several drugs have proven to be effective in their treatment.

Some of medication used to treat the symptoms are:

The National Organization for Rare Disorders (NORD) recommends FLAIR therapy consisting of a three-agent protocol involving front-loaded high-dose ACTH, IVIg, and rituximab that was developed by the National Pediatric Myoclonus Center, and has the best-documented outcomes. [15] Almost all patients (80-90%) show improvement with this treatment and the relapse rate appears to be about 20%. [16]

A more detailed summary of current treatment options can be found at Treatment Options

The following medications should probably be avoided:

Prognosis

Currently, there are no clinically established laboratory investigations available to predict prognosis or therapeutic response.[ citation needed ]

Tumors in children who develop OMS tend to be more mature, showing favorable histology and absence of n-myc oncogene amplification than similar tumors in children without symptoms of OMS. [17] Involvement of local lymph nodes is common, but these children rarely have distant metastases and their prognosis, in terms of direct morbidity and mortality effects from the tumor, is excellent. [18] The three-year survival rate for children with non-metastatic neuroblastoma and OMS was 100% according to Children's Cancer Group data (gathered from 675 patients diagnosed between 1980 and 1994); three-year survival in comparable patients with OMS was 77%. [19] Although the symptoms of OMS are typically steroid-responsive and recovery from acute symptoms of OMS can be quite good, children often experience lifelong neurologic sequelae that impair motor, cognitive, language, and behavioral development. [20] [21]

Most children will experience a relapsing form of OMS, though a minority will have a monophasic course and may be more likely to recover without residual deficits. [22] Viral infection may play a role in the reactivation of disease in some patients who had previously experienced remission, possibly by expanding the memory B cell population. [23] Studies have generally asserted that 70-80% of children with OMS will have long-term neurologic, cognitive, behavioral, developmental, and academic impairment. Since neurologic and developmental difficulties have not been reported as a consequence of neuroblastoma or its treatment, it is thought that these are exclusively due to the immune mechanism underlying OMS. [24]

One study concludes that: "Patients with OMA and neuroblastoma have excellent survival but a high risk of neurologic sequelae. Favourable disease stage correlates with a higher risk for development of neurologic sequelae. The role of anti-neuronal antibodies in late sequelae of OMA needs further clarification". [19]

Another study states that: "Residual behavioral, language, and cognitive problems occurred in the majority". [25]

Research

The National Institute of Neurological Disorders and Stroke (NINDS) conducts and supports research on various movement disorders, including opsoclonus myoclonus. These studies are focused on finding ways to prevent, treat, and cure these disorders, as well as increasing knowledge about them. [26]

Nomenclature

OMS was first described by Marcel Kinsbourne in 1962. [27] (The term 'Opsoclonus' was coined by Orzechowski in 1913, but it was classically described and associated with neuroblastoma by Kinsbourne). Other names for OMS include:[ citation needed ]

Related Research Articles

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References

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  27. Pranzatelli, Michael R. (1992). "The neurobiology of the opsoclonus-myoclonus syndrome". Clinical Neuropharmacology . 15 (3): 186–288. CiteSeerX   10.1.1.552.7340 . doi:10.1097/00002826-199206000-00002. PMID   1394242. myoclonic encephalopathy (3-10) of infants (7,11-15) or childhood (16,17), dancing eyes (18,19), dancing feet (20), infantile polymyoclonia (21-23) or polymyoclonus syndrome (20,24-26), opsoclonus syndrome (27,28), acute cerebellar encephalopathy (29-32), encephalitis (33), or ataxia (34), syndrome of rapid irregular movements of eyes and limbs in childhood (35), oculocerebellomyoclonic syndrome (36-38), Kinsbourne syndrome (9,39-41), opsoclonus, body tremulousness, and benign encephalitis (42-43), syndrome of ocular oscillations and truncal myoclonus (44), encephalopathy associated with occult neuroblastoma (45), opsomyoclonus (46-48), or opsoclonus-myoclonus (49-55), opsoclonic cerebellopathy (56,57), or simply opsoclonus (58-60). The description opsoclonus, myoclonus, ataxia, (61) and encephalopathy (62) may be the most complete, but opsoclonus-myoclonus will be used here.

Further reading