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Certo F, Salvucci G, Casellato C, Gambini C, Oggioni GD, Bocci T, Priori A. Non-nystagmus hyperkinetic eye movement disorders. Neurol Sci 2025:10.1007/s10072-024-07873-2. [PMID: 40080371 DOI: 10.1007/s10072-024-07873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 11/04/2024] [Indexed: 03/15/2025]
Abstract
BACKGROUND While nystagmus is an involuntary ocular movement relatively frequent, well described, and easily recognized by most practitioners, non-nystagmus hyperkinetic eye movement disorders (NHEMD) are less obvious and can be overlooked. NHEMD may arise from intrinsic abnormalities in ocular muscles and oculomotor nerves, brain and brainstem lesions, systemic diseases, dysimmune disorders, drugs or can even be functional in nature. Given that some treatable disorders initially manifest with NHEMD, their knowledge becomes crucial. AIMS This review aims to offer a practical and comprehensive guide to recognize specific types of NHEMD, to choose the appropriate diagnostic tests and treatments. RESULTS The review approaches individual NHEMD based on the location of anatomical lesions and the underlying pathophysiological mechanisms; therefore, it begins with those arising from abnormalities in extraocular muscles or oculomotor nerves (as for example, superior oblique myokymia and ocular neuromyotonia), then moves to NHEMD due to brainstem and brain involvement (as for example, ocular bobbing, opsoclonus, and tonic downward gaze deviation). Lastly, functional NHEMD and nonnystagmus ocular hyperkinesias associated with specific neurological disorders, such as Parkinson's disease or blepharospasm will be considered. CONCLUSION Overall, the review offers a comprehensive reappraisal of hyperkinetic disorders of eye motility.
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Affiliation(s)
- Francesco Certo
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giulia Salvucci
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy
| | - Chiara Casellato
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy
| | - Chiara Gambini
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy
| | - Gaia Donata Oggioni
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy
| | - Tommaso Bocci
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy
| | - Alberto Priori
- Clinical Neurology and Movement Disorders Units, San Paolo University Hospital, University of Milan, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, 20142, Italy.
- Department of Health Sciences and Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.
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Delap S, Shah N, Kuns O, Franklin B, Skeens MA. Successful use of tacrolimus for treatment-refractory neuroblastoma-associated opsoclonus-myoclonus-ataxia syndrome: A case series. Pediatr Blood Cancer 2024; 71:e30903. [PMID: 38321586 DOI: 10.1002/pbc.30903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
Opsoclonus-myoclonus-ataxia syndrome (OMAS) is an autoimmune central nervous system disorder, primarily manifesting as a paraneoplastic sequalae to neuroblastoma, and characterized by motor disorders and behavioral disturbances. OMAS is typified by aberrant B-cell and T-cell activation. Current treatment involves immunosuppression using corticosteroids, intravenous immunoglobulin, and rituximab. However, these approaches often lead to treatment-related toxicities and symptomatic recurrences with chronic neurocognitive impairment. We treated three children with refractory neuroblastoma-associated OMAS with tacrolimus, a T-cell-targeting calcineurin inhibitor, effectively controlling symptoms within a month and enabling the discontinuation of immunosuppression with minimal side effects. Tacrolimus shows promise as a therapeutic option for refractory OMAS.
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Affiliation(s)
- Sara Delap
- Department of Hospital Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nilay Shah
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olivia Kuns
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Bianca Franklin
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Micah A Skeens
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
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Opsoclonus-Myoclonus Syndrome in Children and Adolescents: A Therapeutic Challenge. CHILDREN 2021; 8:children8110965. [PMID: 34828678 PMCID: PMC8625142 DOI: 10.3390/children8110965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Opsoclonus-myoclonus syndrome (OMS) is a neurological non-fatal disease that usually responds to immunotherapies. However, the real challenge is to counteract the high frequency of relapses and long-term developmental sequelae. Since the OMS is extremely rare, a common consensus regarding therapeutic guidelines is still lacking. The goals of this study were to test whether ACTH was superior to other immunotherapies and to investigate whether an early treatment could improve the outcome. Sixteen children affected by OMS were retrospectively reviewed. Eight children had a neuroblastic tumor. The other eight patients were affected by non-paraneoplastic OMS. Overall, the most commonly used treatment was corticotherapy (n = 11). However, ACTH (n = 10), rituximab (n = 7), immunoglobulins (n = 4), cyclophosphamide (n = 3), and mycophenolate (n = 2) were also administered. ACTH was associated with a high percentage of patients who healed (80%) and, as a first-line therapy, was associated with a lower incidence of relapses. An early treatment was associated with a favorable long-term outcome. Long-term sequelae occurred in 42% of patients who were treated early and in all of those who were treated late. It is advisable for the affected children to be identified at an early time, as they may benefit from an early treatment. ACTH represents an effective treatment with a high probability of recovery and low rate of relapses.
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The Treatment of Opsoclonus-Myoclonus Syndrome Secondary to Neuroblastic Tumours-Single-Centre Experience and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56080412. [PMID: 32823831 PMCID: PMC7466285 DOI: 10.3390/medicina56080412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
Background and Objectives: The opsoclonus-myoclonus syndrome (OMS) is characterised by opsoclons, myoclons and impaired balance, often concomitant with sleep disorder and behavioural difficulties. The symptoms develop as a result of autoimmune response triggered by a neuroblastic tumour (NT). OMS can also develop secondarily to a viral infection or as an immune response triggered by an unknown agent. This leads to the activation of B- and T-cells, which produce and release autoantibodies or cytokines directly within the central nervous system (CNS), thus damaging the neurons within the cerebellum and the brain stem. The available OMS treatments aim at decreasing lymphocyte, cytokine and autoantibody production or accelerating the utilisation of the latter. Another treatment option for OMS involves using cytostatic agents, which damage T- and B-cells causing their depletion and impaired function, which reduces their ability to produce antibodies and cytokines. Materials and Methods: We present a single-centre experience in treating OMS secondary to NT in 7 children. Results: The combined treatment with cyclophosphamide plus dexamethasone resulted in a complete resolution of OMS symptoms in 4 children, and a significant improvement in the 3 children. Two of them periodically present hyperactivity, and one girl requires an additional support at school due to special educational needs (SEN). Conclusions: NT resection does not resolve OMS in children with OMS secondary to NT. The combined treatment with dexamethasone plus cyclophosphamide seems to be an effective treatment of OMS.
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Johnston DL, Murray S, Irwin MS, Doyle J, Schechter T. Autologous stem cell transplantation for refractory opsoclonus myoclonus ataxia syndrome. Pediatr Blood Cancer 2018; 65:e27110. [PMID: 29693780 DOI: 10.1002/pbc.27110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Abstract
Opsoclonus, myoclonus, ataxia syndrome (OMA) is a severe neurologic disorder often associated with neuroblastoma. It is challenging to treat and can have long-term neurologic sequelae. Current recommended therapies include intravenous immunoglobulin, corticosteroids, rituximab, and chemotherapy (cyclophosphamide). We present two cases who were refractory to conventional therapy and underwent autologous stem cell transplantation (ASCT). One patient had complete resolution of symptoms following ASCT and the other patient had minimal change in symptoms with this therapy. These findings support consideration of ASCT as a therapeutic option for patients with refractory OMA after failure of known effective therapies.
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Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sean Murray
- Department of Pediatrics, Health Sciences North, Sudbury, Ontario, Canada
| | - Meredith S Irwin
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Doyle
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Tal Schechter
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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Feng JJ, Ontaneda D. Treating primary-progressive multiple sclerosis: potential of ocrelizumab and review of B-cell therapies. Degener Neurol Neuromuscul Dis 2017; 7:31-45. [PMID: 30050376 PMCID: PMC6053100 DOI: 10.2147/dnnd.s100096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) therapy has evolved rapidly with an increased availability of several immunomodulating therapies over the past two decades. Disease-modifying therapies have proven to be effective in treating relapse-remitting MS (RRMS). However, clinical trials involving some of the same agents for secondary-progressive and primary-progressive MS (SPMS and PPMS) have been largely negative. The pathogenesis of progressive MS remains unclear, but B-cells may play a significant role in chronic compartmentalized inflammation, likely contributing to disease progression. Biologics targeted at B-cells, such as rituximab, are effective in treating RRMS. Ocrelizumab is a humanized monoclonal antibody to CD20+ B-cells that has shown positive results in PPMS with a significant reduction in disease progression. This review aims to discuss in detail the involvement of B-cells in MS pathogenesis, current progress of currently available and investigational biologics, with focus on ocrelizumab, and future prospects for B-cell therapy in PPMS.
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Affiliation(s)
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA,
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