Opsoclonus myoclonus syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Synonyms and keywords:

Overview

Opsoclonus myoclonus syndrome (OMS) is a rare neurological disorder, which can be very heterogenous, presenting itself with many different symptoms such as opsoclonus and/or myoclonus - which name the syndrome, but also ataxia, behavioral and/or sleep disturbances. It is believed to be caused by an immune system dysfunction, either induced by infection or paraneoplastic etiologies.

Historical Perspective

• Opsoclonus myoclonus syndrome was first described in 1962 by M. Kinsbourne, who presented a series of six cases of children with ataxia, myoclonus and opsoclonus.
• The syndrome was named as "myoclonic encephalopathy", but has also been called as "dancing eye syndrome". Recently it has been more often referred to as opsoclonus myoclonus syndrome.

Classification

• There is no established system for the classification of opsoclonus myoclonus syndrome.

Pathophysiology

• The pathogenesis of opsoclonus myoclonus syndrome is characterized by neuroinflammation involving dysregulated B cells. It is believed that loss of tolerance and autoantibody production causes the neurological damage seen in the disease.
• Cerebrospinal fluid studies have shown B cell recruitment to the brain via CXCL13/CXCR5 and CXCL10/ CXCR3 ligand/receptor pairs. The B cell activating factor plays a role increasing B cell survivability and there may be seen intrathecal production of oligoclonal bands.
• It is not known if the triggers that causes opsoclonus myoclonus syndrome and those that causes relapses of the disease are the same or if they affect the same region of the brain.
  
• The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Differentiating [disease name] from other Diseases

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

• [Differential dx1]
• [Differential dx2]
• [Differential dx3]

Epidemiology and Demographics

• The prevalence of opsoclonus myoclonus syndrome is approximately 1 per 1,000,000 individuals worldwide.

Age

• Opsoclonus myoclonus syndrome is more commonly observed among patients aged 18 months old and may occur up to 5-6 years old.
• Relapses of the disease may affect adults.

Gender

• Girls are slightly more affected with opsoclonus myoclonus syndrome than boys.

Race

• There is no racial predilection for opsoclonus myoclonus syndrome.

Risk Factors

• Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

The component features of OMS include repeated, random and rapid eye movements in both horizontal, vertical and diagonal directions (opsoclonus); unsteady gait or loss of ability to stand and walk (ataxia); brief, repeated, shock-like spasms of several muscles within the arms, legs (myoclonus), or tremor interfering with hand use. Behavioral and sleep disturbances, including extreme irritability, inconsolable crying, reduced and fragmented sleep (insomnia) and rage attacks are common. Difficulty articulating speech (dysarthria), sometimes with complete loss of speech and language may occur. Additional symptoms such as decreased muscle tone (hypotonia) and vomiting are common.

• [Disease name] is usually asymptomatic.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory markers associated with opsoclonus myoclonus syndrome.

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

• There are no [imaging study] findings associated with [disease name].

• [Imaging study 1] is the imaging modality of choice for [disease name].
• On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
• [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References

• Armstrong MB. Robertson PL. Castle VP. Delayed, recurrent opsoclonus-myoclonus syndrome responding to plasmapheresis. Pediatric Neurology. 33(5): 365-7, 2005 Nov.
• Cooper R. Khakoo Y. Matthay KK. Lukens JN. Seeger RC. Stram DO. Gerbing RB. Nakagawa A. Shimada H. Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: histopathologic features-a report from the Children's Cancer Group. Medical & Pediatric Oncology. 36(6): 623-9, 2001 Jun.
• Dale RC. Childhood opsoclonus myoclonus. Lancet Neurology. 2(5): 270, 2003 May.
• Gesundheit B. Smith CR. Gerstle JT. Weitzman SS. Chan HS. Ataxia and secretory diarrhea: two unusual paraneoplastic syndromes occurring concurrently in the same patient with ganglioneuroblastoma. Journal of Pediatric Hematology/Oncology. 26(9): 549-52, 2004 Sep.
• Hayward K. Jeremy RJ. Jenkins S. Barkovich AJ. Gultekin SH. Kramer J. Crittenden M. Matthay KK. Long-term neurobehavioral outcomes in children with neuroblastoma and opsoclonus-myoclonus-ataxia syndrome: relationship to MRI findings and anti-neuronal antibodies. Journal of Pediatrics. 139(4): 552-9, 2001 Oct.
• Kinsbourne M. Myoclonic enecphalopathy of infants. Journal of Neurology, Neurosurgery, Psychiatry 25:271-276, 1962.
• Mezey LE. Harris CM. Adaptive control of saccades in children with dancing eye syndrome. Annals of the New York Academy of Sciences. 956: 449-52, 2002 Apr.
• Mitchell WG. Davalos-Gonzalez Y. Brumm VL. Aller SK. Burger E. Turkel SB. Borchert MS. Hollar S. Padilla S. Opsoclonus-ataxia caused by childhood neuroblastoma: developmental and neurologic sequelae. Pediatrics. 109(1): 86-98, 2002 Jan.
• Pranzatelli, M. R., Travelstead, A. L., Tate, E. D., Allison, T. J.,Moticka, E. J., Franz, D. N., Nigro, M. A., Parke, J. T., Stumpf, D. A., Verhulst, S. J. (2004). B- and T-cell markers in opsoclonus-myoclonus syndrome: Immunophenotyping of CSF lymphocytes. Neurology 62: 1526-1532
• Rudnick E. Khakoo Y. Antunes NL. Seeger RC. Brodeur GM. Shimada H. Gerbing RB. Stram DO. Matthay KK. Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: clinical outcome and antineuronal antibodies-a report from the Children's Cancer Group Study. Medical & Pediatric Oncology. 36(6): 612-22, 2001 Jun.
• Longitudinal Neurodevelopmental Evaluation of Children With Opsoclonus-Ataxia. PEDIATRICS Vol. 116 No. 4 October 2005, pp. 901-907 (doi:10.1542/peds.2004-2377)

External links

• An active OMS Support forum
• short description of OMS
• OMS Support Network
• The National Pediatric Myoclonus Center (US)
• Dancing eyes syndrome (UK name for OMS)
• National Organization for Rare Disorders, Inc.
• A blog about Amelia, an OMS patient diagnosed at 4.5 years (stage I neuroblastoma)
• The experience of a man who had OMS at age 32
• Chase Away OMS Foundation: A non-profit foundation dedicated to funding research to improve the diagnosis, treatment and ultimately find a cure for OMS

• Antibody information related to opsocponus