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Norrito RL, Puleo MG, Pintus C, Basso MG, Rizzo G, Di Chiara T, Di Raimondo D, Parrinello G, Tuttolomondo A. Paraneoplastic Cerebellar Degeneration Associated with Breast Cancer: A Case Report and a Narrative Review. Brain Sci 2024; 14:176. [PMID: 38391750 PMCID: PMC10887192 DOI: 10.3390/brainsci14020176] [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: 12/27/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Paraneoplastic neurological syndromes (PNSs) are an uncommon complication of cancer, affecting nearby 1/10,000 subjects with a tumour. PNSs can involve all the central and peripheral nervous systems, the muscular system, and the neuromuscular junction, causing extremely variable symptomatology. The diagnosis of the paraneoplastic disease usually precedes the clinical manifestations of cancer, making an immediate recognition of the pathology crucial to obtain a better prognosis. PNSs are autoimmune diseases caused by the expression of common antigens by the tumour and the nervous system. Specific antibodies can help clinicians diagnose them, but unfortunately, they are not always detectable. Immunosuppressive therapy and the treatment of cancer are the cornerstones of therapy for PNSs. This paper reports a case of PNSs associated with breast tumours and focuses on the most common paraneoplastic neurological syndromes. We report a case of a young female with a clinical syndrome of the occurrence of rigidity in the right lower limb with postural instability with walking supported and diplopia, with a final diagnosis of paraneoplastic cerebellar degeneration and seronegative rigid human syndrome associated with infiltrating ductal carcinoma of the breast.
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Affiliation(s)
- Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Puleo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Chiara Pintus
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Basso
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Giuliana Rizzo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Tiziana Di Chiara
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Domenico Di Raimondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Gaspare Parrinello
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
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Ocular flutter as the presenting manifestation of autoimmune glial fibrillary acidic protein astrocytopathy. Clin Neurol Neurosurg 2022; 219:107307. [DOI: 10.1016/j.clineuro.2022.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/15/2022] [Accepted: 05/22/2022] [Indexed: 11/20/2022]
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Osawa K, Sugiyama A, Uzawa A, Hirano S, Yamamoto T, Nezu M, Araki N, Kano H, Kuwabara S. Temporal Changes in Brain Perfusion in a Patient with Myoclonus and Ataxia Syndrome Associated with COVID-19. Intern Med 2022; 61:1071-1076. [PMID: 35110499 PMCID: PMC9038453 DOI: 10.2169/internalmedicine.9171-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Myoclonus and ataxia, with or without opsoclonus, have recently been recognized as a central nervous system syndrome associated with coronavirus disease-2019 (COVID-19). A 52-year-old Japanese man developed myoclonus and ataxia 16 days after the onset of COVID-19. Brain single-photon emission computed tomography (SPECT) revealed hyperperfusion in the cerebellum and hypoperfusion in the cerebral cortices with frontal predominance during the acute stage, which improved over two months. This study indicates that brain perfusion SPECT can be effective in detecting functional alterations in COVID-19-related myoclonus and ataxia.
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Affiliation(s)
- Kenta Osawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Tatsuya Yamamoto
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
- Department of Rehabilitation, Division of Occupational Therapy, Chiba Prefectural University of Health Sciences, Japan
| | - Masahiko Nezu
- Department of Kampo Medicine, Chiba University Hospital, Japan
| | - Nobuyuki Araki
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Kano
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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Koziorowska-Gawron E, Koszewicz M, Bladowska J, Ejma M, Budrewicz S. Opsoclonus-myoclonus syndrome with severe clinical course and beneficial outcome: A case report. Medicine (Baltimore) 2021; 100:e25261. [PMID: 33832088 PMCID: PMC8036019 DOI: 10.1097/md.0000000000025261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Opsoclonus-myoclonus syndrome (OMS) is a rare immune-mediated movement disorder, mostly of paraneoplastic or idiopathic origin. The disease usually has an acute onset, serious course and leads rapidly to disability in adult patients. To the best of our knowledge, this is the fourth presented case of OMS with a severe course and complete reversibility of neurological symptoms in a pregnant woman. This report includes videos and a literature review. PATIENT CONCERNS A 30-year-old woman in the 12th week of pregnancy developed severe nausea and vomiting, after several days balance and gait disorders appeared. On admission to hospital, neurological examination revealed opsoclonus, dysarthria, myoclonic jerks with ataxia of the trunk and limbs with inability to sit, stand or walk. DIAGNOSIS Well-known causes of OMS were excluded. Although in our patient the idiopathic origin of the disorder was taken under consideration, diagnosis of opsoclonus-myoclonus related to the pregnancy was highly likely. INTERVENTIONS After administration of steroids and benzodiazepines the patient improved. OUTCOMES In the 6th month of pregnancy, after termination of immunotherapy, she recovered completely and was able to sit, stand and walk independently. In the 39th week of pregnancy, she delivered a healthy child. LESSONS We confirm that understanding of clinical symptoms and rare causes of OMS contributes to early diagnosis and therapy, which ensures an optimal outcome. One probable cause of OMS could be a physiological change to immune system regulation during pregnancy. The relationship between OMS and pregnancy remains uncertain and needs further investigation.
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Affiliation(s)
| | | | - Joanna Bladowska
- Department of General, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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Ibáñez-Juliá MJ, Pappa E, Gaymard B, Leclercq D, Hautefort C, Tilikete C, Delattre JY, Hoang-Xuan K, Psimaras D, Alentorn A. Brain volumetric analysis and cortical thickness in adults with saccadic intrusions (ocular flutter or opsoclonus-myoclonus syndrome). Clin Neurol Neurosurg 2017; 163:167-172. [PMID: 29121544 DOI: 10.1016/j.clineuro.2017.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/24/2017] [Accepted: 10/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Ocular flutter (OF) and opsoclonus are considered a continuum with a similar pathogenesis. Due to the rarity of this disease in the adult population, little is known about the brain morphological changes in the chronic phase of the disease. PATIENTS AND METHODS Six magnetic resonance imaging from adults with previous history of OF/Opsoclonus and 12 healthy patients (paired by age and sex) were analyzed in order to identify the long term cortical thickness pattern in this rare disease by using Freesurfer. RESULTS Patients with OF/Opsoclonus showed reduced cerebellum cortical volume with a subsequent diminution in total cerebellar volume. White mater cerebellum volume was not modified. In addition, we have also identified a significant supratentorial gray matter volume decrease in OF/Opsoclonus patients, involving both the cortical and the subcortical gray matter. CONCLUSIONS OF/Opsoclonus in adults may be associated with cortical and subcortical gray matter atrophy, as well as decreased cerebellar cortical volume. Further larger prospective studies are necessary to confirm these results.
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Affiliation(s)
- María-José Ibáñez-Juliá
- Department of Neurology 2, Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Université Paris VI, 75013, Paris, France; Institut du Cerveau et de la Moelle Epinière, INSERM U1127 and Centre National de la Recherche Scientifique, Unité de Recherche Mixte, 7225, Paris, France
| | - Evangelia Pappa
- Department of Neurology 2, Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Université Paris VI, 75013, Paris, France; Institut du Cerveau et de la Moelle Epinière, INSERM U1127 and Centre National de la Recherche Scientifique, Unité de Recherche Mixte, 7225, Paris, France
| | - Bertrand Gaymard
- Deparment of Clinical Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France
| | - Delphine Leclercq
- Department of Neuro-radiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France
| | - Charlotte Hautefort
- Otolaryngology - Head and Neck Surgery Department, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris (AP-HP), 75475, Paris, France
| | - Caroline Tilikete
- Neuro-Ophthalmology Unit, Lyon Civil Hospitals, Neurological Hospital, Lyon 1 University, Bron Cedex, France
| | - Jean-Yves Delattre
- Department of Neurology 2, Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Université Paris VI, 75013, Paris, France; Institut du Cerveau et de la Moelle Epinière, INSERM U1127 and Centre National de la Recherche Scientifique, Unité de Recherche Mixte, 7225, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology 2, Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Université Paris VI, 75013, Paris, France; Institut du Cerveau et de la Moelle Epinière, INSERM U1127 and Centre National de la Recherche Scientifique, Unité de Recherche Mixte, 7225, Paris, France
| | - Dimitri Psimaras
- Department of Neurology 2, Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Université Paris VI, 75013, Paris, France; Institut du Cerveau et de la Moelle Epinière, INSERM U1127 and Centre National de la Recherche Scientifique, Unité de Recherche Mixte, 7225, Paris, France
| | - Agusti Alentorn
- Department of Neurology 2, Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), 75013, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie, Université Paris VI, 75013, Paris, France; Institut du Cerveau et de la Moelle Epinière, INSERM U1127 and Centre National de la Recherche Scientifique, Unité de Recherche Mixte, 7225, Paris, France.
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Optican LM, Pretegiani E. A GABAergic Dysfunction in the Olivary-Cerebellar-Brainstem Network May Cause Eye Oscillations and Body Tremor. II. Model Simulations of Saccadic Eye Oscillations. Front Neurol 2017; 8:372. [PMID: 28824529 PMCID: PMC5543285 DOI: 10.3389/fneur.2017.00372] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/17/2017] [Indexed: 01/15/2023] Open
Abstract
Eye and body oscillations are shared features of several neurological diseases, yet their pathophysiology remains unclear. Recently, we published a report on two tennis players with a novel presentation of eye and body oscillations following self-administration of performance-enhancing substances. Opsoclonus/flutter and limb tremor were diagnosed in both patients. Common causes of opsoclonus/flutter were excluded. High-resolution eye movement recordings from one patient showed novel spindle-shaped, asymmetric saccadic oscillations (at ~3.6 Hz) and ocular tremor (~40-60 Hz). Based on these findings, we proposed that the oscillations are the result of increased GABAA receptor sensitivity in a circuit involving the cerebellum (vermis and fastigial nuclei), the inferior olives, and the brainstem saccade premotor neurons (excitatory and inhibitory burst neurons, and omnipause neurons). We present a mathematical model of the saccadic system, showing that the proposed dysfunction in the network can reproduce the types of saccadic oscillations seen in these patients.
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Affiliation(s)
- Lance M. Optican
- Laboratory of Sensorimotor Research, IRP, National Eye Institute, National Institutes of Health, Bethesda, MD, United States
| | - Elena Pretegiani
- Laboratory of Sensorimotor Research, IRP, National Eye Institute, National Institutes of Health, Bethesda, MD, United States
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Oh SY, Boegle R, Eulenburg PZ, Ertl M, Kim JS, Dieterich M. Longitudinal multi-modal neuroimaging in opsoclonus–myoclonus syndrome. J Neurol 2017; 264:512-519. [DOI: 10.1007/s00415-016-8389-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
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8
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Blaes F, Dharmalingam B. Childhood opsoclonus-myoclonus syndrome: diagnosis and treatment. Expert Rev Neurother 2016; 16:641-8. [DOI: 10.1080/14737175.2016.1176914] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Anand G, Bridge H, Rackstraw P, Chekroud AM, Yong J, Stagg CJ, Pike M. Cerebellar and cortical abnormalities in paediatric opsoclonus-myoclonus syndrome. Dev Med Child Neurol 2015; 57:265-72. [PMID: 25290446 DOI: 10.1111/dmcn.12594] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/28/2022]
Abstract
AIM Paediatric opsoclonus-myoclonus syndrome (OMS) is a poorly understood condition with long-term cognitive, behavioural, and motor sequelae. Neuroimaging has indicated cerebellar atrophy in the chronic phase, but this alone may not explain the cognitive sequelae seen in many children with OMS. This study aimed to determine the extent of structural change throughout the brain that may underpin the range of clinical outcomes. METHOD Nine participants with OMS (one male, eight females; mean age [SD] 14y, [6y 5mo], range 12-30y) and 10 comparison individuals (three males, seven females; mean age 12y 6mo, [4y 9mo], range 10-23y) underwent magnetic resonance imaging to acquire T1-weighted structural images, diffusion-weighted images, and magnetic resonance spectroscopy scans. Neuroblastoma had been present in four participants with OMS. Voxel-based morphometry was used to determine changes in grey matter volume, tract-based spatial statistics to analyze white matter integrity, and Freesurfer to analyze cortical thickness across visual and motor cortices. RESULTS Whole-brain analysis indicated that cerebellar grey matter was significantly reduced in the patients with OMS, particularly in the vermis and flocculonodular lobe. A region-of-interest analysis indicated significantly lower cerebellar grey matter volume, particularly in patients with the greatest OMS scores. Diffusion-weighted images did not show effects at a whole brain level, but all major cerebellar tracts showed increased mean diffusivity when analysis was restricted to the cerebellum. Cortical thickness was reduced across the motor and visual areas in the OMS group, indicating involvement beyond the cerebellum. INTERPRETATION Across individuals with OMS, there is considerable cerebellar atrophy, particularly in the vermis and flocculonodular lobes with atrophy severity associated with persistent symptomatology. Differences in cerebral cortical thickness indicate disease effects beyond the cerebellum.
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Affiliation(s)
- Geetha Anand
- Department of Paediatric Neurology, Children's Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Mustafa M, Levin J, Schöberl F, Rominger A. Postinfectious Opsoclonus-Myoclonus Syndrome in a 41-Year-Old Patient-Visualizing Hyperactivation in Deep Cerebellar Nuclei by Cerebral [18
F]-FDG- PET. J Neuroimaging 2014; 25:683-5. [DOI: 10.1111/jon.12204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/27/2014] [Accepted: 09/13/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mona Mustafa
- Department of Nuclear Medicine; University of Munich; Germany
| | | | | | - Axel Rominger
- Department of Nuclear Medicine; University of Munich; Germany
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Blaes F, Fühlhuber V, Preissner KT. Identification of autoantigens in pediatric opsoclonus-myoclonus syndrome. Expert Rev Clin Immunol 2014; 3:975-82. [DOI: 10.1586/1744666x.3.6.975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shindo K, Onohara A, Hata T, Kobayashi F, Nagasaka K, Nagasaka T, Takiyama Y. Opsoclonus-myoclonus syndrome associated with multiple system atrophy. CEREBELLUM & ATAXIAS 2014; 1:15. [PMID: 26331039 PMCID: PMC4552143 DOI: 10.1186/s40673-014-0015-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/29/2014] [Indexed: 11/10/2022]
Abstract
Opsoclonus-myoclonus syndrome (OMS) is well known as a paraneoplastic syndrome or as a parainfectious neurologic complication. However, OMS associated with a neurodegenerative disorder has not been described previously. A 48-year-old woman had been diagnosed as multiple system atrophy-parkinsonian type (MSA-P) based on the findings of dopamine non-responsive parkinsonism with autonomic failure and typical findings on magnetic resonance imaging 5 years ago. She exhibited recurrent asynchronous and arrhythmic myoclonic movements of the upper limbs and abdomen with a very short duration, and involuntary eye movements, which were repetitive, rapid, random, multidirectional, conjugate saccades of irregular amplitude and frequency at rest. Based on hematological and radiological findings, the diagnosis was advanced MSA-P associated with OMS. As far as we are aware, there have not been any previous reports of such a case.
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Affiliation(s)
- Kazumasa Shindo
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
| | - Akiko Onohara
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
| | - Takanori Hata
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
| | - Fumikazu Kobayashi
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
| | - Kaori Nagasaka
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
| | - Takamura Nagasaka
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
| | - Yoshihisa Takiyama
- Department of Neurology, University of Yamanashi Hospital, 1110 Tamaho, Yamanashi, 409-3898 Japan
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Boland T, Strause J, Hu M, Santamaria D, Liang TW, Kremens D, Sergott R, Moussouttas M. Posterior Reversible Encephalopathy Syndrome Presenting as Opsoclonus-Myoclonus. Neuroophthalmology 2012; 36:149-152. [PMID: 23125471 PMCID: PMC3483062 DOI: 10.3109/01658107.2012.667186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/12/2012] [Accepted: 01/12/2012] [Indexed: 11/13/2022] Open
Abstract
Opsoclonus-myoclonus may be caused by various neurological conditions and toxic-metabolic states, but typically occurs as a parainfectious or paraneoplastic manifestation. The development of opsoclonus-myo-clonus has been variably attributed to lesions in the pons or cerebellum. Herein the authors describe a case of opsoclonus-myoclonus due to posterior reversible encephalopathy syndrome in which magnetic resonance imaging revealed lesions in the region of the cerebellar dentate nuclei. Clinical and radiological resolution of the opsoclonus-myoclonus and of the posterior reversible encephalopathy syndrome followed antihyperten-sive therapy.
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Affiliation(s)
- Torrey Boland
- Department of Neurology, Thomas Jefferson Medical Center, Philadelphia, Pennsylvania, USA
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14
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Newey CR, Sarwal A, Wu G. Radiological Correlate of Ocular Flutter in a Case with Paraneoplastic Encephalitis. J Neuroimaging 2011; 23:251-3. [DOI: 10.1111/j.1552-6569.2011.00659.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sakuma H, Shimizu Y, Saito Y, Sugai K, Inagaki M, Kaga M, Sasaki M. Electrophysiological evidence of cerebral dysfunction in childhood opsoclonus-myoclonus syndrome. Mov Disord 2010; 25:940-5. [DOI: 10.1002/mds.23084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Paliwal VK, Chandra S, Verma R, Kalita J, Misra UK. Clonazepam responsive opsoclonus myoclonus syndrome: additional evidence in favour of fastigial nucleus disinhibition hypothesis? J Neural Transm (Vienna) 2010; 117:613-5. [DOI: 10.1007/s00702-010-0366-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 01/07/2010] [Indexed: 11/29/2022]
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Wilken B, Baumann M, Bien CG, Hero B, Rostasy K, Hanefeld F. Chronic relapsing opsoclonus-myoclonus syndrome: combination of cyclophosphamide and dexamethasone pulses. Eur J Paediatr Neurol 2008; 12:51-5. [PMID: 17625938 DOI: 10.1016/j.ejpn.2007.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 05/15/2007] [Accepted: 05/19/2007] [Indexed: 11/20/2022]
Abstract
Opsoclonus-myoclonus syndrome (OMS) is a rare and debilitating disorder of unknown etiology affecting children and adults. Outcome is unfavourable; approximately 80% of children with OMS suffer from mild to severe neurological handicaps, mainly cognitive impairment. A standard therapy does not exist. Due to the possible immune-mediated mechanisms, treatment with steroids, ACTH, plasmapheresis and immunoglobulins can be successful. However, some children become steroid dependent and symptoms may reoccur after treatment has been finished. We present two girls with OMS, who had a prolonged clinical course lasting 4 and 9 years with many relapses. Both children developed symptoms around the age of two years. Diagnostic work-up to exclude neuroblastoma was negative. Several treatment modalities including oral steroids, dexamethasone pulses, immunoglobulin and cyclosporine were used without lasting success. In addition, cognitive impairment developed in both children. In order to prevent further clinical and mental deterioration, 6 pulses of cyclophosphamide in combination with dexamethasone pulses every 4 weeks were administered. Both children showed significant improvement of OMS symptoms. One girl is still symptom free 18 months after treatment, mild ataxia developed in the other after 12 months. Both children are mentally handicapped and in special need schools. We conclude that combination of cyclophosphamide pulses and dexamethasone pulse therapy is a therapeutic option even after a long clinical course to improve symptoms of OMS.
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Affiliation(s)
- B Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Germany.
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Abstract
PURPOSE OF REVIEW The aim of this article is to review opsoclonus, with particular emphasis on its immunopathogenesis and pathophysiology. RECENT FINDINGS Infections (West Nile virus, Lyme disease), neoplasms (non-Hodgkin's lymphoma, renal adenocarcinoma), celiac disease, and allogeneic hematopoietic stem cell transplantation can cause opsoclonus. Newly identified autoantibodies include antineuroleukin, antigliadin, antiendomysial, and anti-CV2. Evidence suggests that the autoantigens of opsoclonus reside in postsynaptic density, or on the cell surface of neurons or neuroblastoma cells (where they exert antiproliferative and proapoptotic effects). Most patients, however, are seronegative for autoantibodies. Cell-mediated immunity may also play a role, with B and T-cell recruitment in the cerebrospinal fluid linked to neurological signs. Rituximab, an anti-CD20 monoclonal antibody, seems efficacious as an adjunctive therapy. Although changes in synaptic weighting of saccadic burst neuron circuits in the brainstem have been implicated, disinhibition of the fastigial nucleus in the cerebellum, or damage to afferent projections to the fastigial nucleus, is a more plausible pathophysiologic mechanism which is supported by functional magnetic resonance imaging findings in patients. SUMMARY There is increasing recognition that both humoral and cell mediated immune mechanisms are involved in the pathogenesis of opsoclonus. Further studies are needed to further elucidate its immunopathogenesis and pathophysiology in order to develop novel and efficacious therapy.
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Affiliation(s)
- Agnes Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Hospital For Sick Children, Toronto, Ontario, Canada.
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19
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van Toorn R, Rabie H, Warwick JM. Opsoclonus-myoclonus in an HIV-infected child on antiretroviral therapy--possible immune reconstitution inflammatory syndrome. Eur J Paediatr Neurol 2005; 9:423-6. [PMID: 16269259 DOI: 10.1016/j.ejpn.2005.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Indexed: 11/29/2022]
Abstract
The exact immunopathogenesis and neuroanatomical localization of opsoclonus-myoclonus ataxia syndrome remains unclear. We describe a 1 year 9 month old girl who, shortly after commencement of highly active antiretroviral therapy developed opsoclonus-myoclonus syndrome and subsequently died of disseminated cytomegalovirus infection. We postulate on the etiological factors that may have played a role in the disease pathogenesis of the patient's opsoclonus-myoclonus ataxia. Immune reconstitution inflammatory syndrome was considered the most likely because of the initial CD4 depletion and the onset of symptoms shortly after initiation of antiretroviral therapy. Single photon emission computed tomography (SPECT) proved helpful by localizing the area of dysfunction to the cerebellar vermis.
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Affiliation(s)
- Ronald van Toorn
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, P.O. Box 19063, Tygerberg 7505, Clinical Building 2nd Floor, Tygerberg, Western Cape, South Africa.
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20
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Helmchen C, Rambold H, Erdmann C, Mohr C, Sprenger A, Binkofski F. The role of the fastigial nucleus in saccadic eye oscillations. Ann N Y Acad Sci 2004; 1004:229-40. [PMID: 14662462 DOI: 10.1196/annals.1303.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
For the first time, we provide functional magnetic resonance imaging evidence for a recent hypothesis that saccadic oscillations in opsoclonus may result from a disinhibition of the cerebellar fastigial nuclei. Two patients with severe opsoclonus were examined during fixation in the light and during eye closure and in darkness where opsoclonus disappeared. Their activation during opsoclonus was compared with 10 healthy subjects performing visually guided and self-paced saccades in the light and darkness. In contrast to the control subjects, the patients showed a strong bilateral midline cerebellar activation that involved the deep cerebellar nuclei. This is probably not just a secondary finding in the fastigial nuclei due to the high frequent saccadic activity because there was, concomitantly, no oculomotor vermal activation, which is normally seen in healthy subjects. We propose that cerebellar activation of the fastigial nuclei may cause opsoclonus via their projections to the brainstem saccadic generator.
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21
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Abstract
The term "myoclonus" sounds esoteric, yet it is part of our normal physiology, occurring as a muscle jerk on drowsiness or falling asleep, during rapid eye movement (REM) sleep, and as hiccoughs. Myoclonus is also a developmental feature of the human nervous system, comprising some of the earliest fetal movements. In pathologic settings, myoclonus may be the only neurologic abnormality, as in essential myoclonus, but more often it is one symptom of a larger neurologic problem. The vast etiologic spectrum of symptomatic myoclonus can be bewildering, but defining the underlying problem may provide the opportunity to develop specific therapies. Otherwise, treatment is merely symptomatic. The approach to the patient should be to verify the nature of the movement disorder and establish a specific etiologic diagnosis. A battery of neurophysiologic, neuroradiologic, and other laboratory studies is needed to localize the origin of the myoclonus and identify causative lesions. Drug treatment is largely empiric but must be systematic and aimed at restoring activities of everyday living. Unlike in epilepsies, in myoclonus multiple drugs usually must be combined to attain functional improvement.
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Affiliation(s)
- Michael R Pranzatelli
- Department of Neurology, National Pediatric Myoclonus Center, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
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22
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Affiliation(s)
- Laura E Mezey
- Department of Ophthalmology and Visual Sciences Unit, Great Ormond Street Hospital, and Institute of Child Health, London, UK.
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23
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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. J Pediatr 2001; 139:552-9. [PMID: 11598603 DOI: 10.1067/mpd.2001.118200] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Opsoclonus-myoclonus-ataxia (OMA) syndrome affects 2% to 3% of patients with neuroblastoma. This study examined relationships between long-term neurobehavioral outcomes and potential biologic markers of OMA, including chronic changes on magnetic resonance imaging (MRI) brain scanning and prevalence of late antineuronal antibodies. STUDY DESIGN Children with neuroblastoma and OMA were identified through medical record review of patients treated at the University of California at San Francisco Medical Center from 1979 to 1999. Eleven patients with a mean follow-up time of 7.6 years underwent standard neurologic, neurocognitive, developmental/behavioral, and academic assessments. Consenting patients underwent MRI brain scanning and a blood draw. Sera were analyzed for the presence of antineuronal immunoreactivity. RESULTS Two (18%) patients had no observed neurologic abnormalities, 7 (64%) demonstrated mild deficits, and 2 (18%) had severe neurologic deficits. However, on neurocognitive, behavioral, and academic assessments, 6 (55%) children performed within the average range, 1 (9%) was moderately below average and 4 (36%) had severe cognitive and behavioral deficiencies. Brain MRI in 5 of 5 patients was notable for cerebellar atrophy without supratentorial involvement. Antineuronal activity was detected in sera of 0 of 10 children at follow-up. CONCLUSIONS Certain patients with neuroblastoma associated OMA may achieve average-range neurobehavioral function in spite of residual neurologic abnormalities, with suggestion of continued improvement over time. Late cerebellar atrophy appears to be a common finding regardless of neurologic outcome, whereas antineuronal immune reactivity does not appear to be a long-term feature of OMA.
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Affiliation(s)
- K Hayward
- Department of Pediatrics, the Pediatric Clinical Research Center, University of California San Francisco, USA
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Bhidayasiri R, Somers JT, Kim JI, Ramat S, Nayak S, Bokil HS, Leigh RJ. Ocular oscillations induced by shifts of the direction and depth of visual fixation. Ann Neurol 2001; 49:24-8. [PMID: 11198292 DOI: 10.1002/1531-8249(200101)49:1<24::aid-ana6>3.0.co;2-t] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Shifts of the point of fixation between two targets aligned on one eye that are located near and far (Müller paradigm) stimulates a combined saccadic-vergence movement. In normal subjects, this test paradigm often induces saccadic oscillations of about 0.3 degrees at 20 to 30 Hz. We measured eye movements using the magnetic search coil technique in 2 patients recovering from viral opsoclonus-myoclonus syndrome, comparing saccadic-vergence responses to the Müller paradigm with conjugate saccades between distant targets. Both patients exhibited intermittent conjugate ocular oscillations of about 4 to 5 degrees amplitude at about 10 Hz. Combined saccadic-vergence movements induced these oscillations twice as often as did conjugate saccades. One patient also exhibited disjunctive ocular oscillations at 10 Hz while sustaining fixation on the near target. The Müller paradigm provides a useful clinical and experimental technique for inducing saccadic oscillations. The probable mechanism is that pontine omnipause neurons, which normally gate saccades, are inhibited during the sustained vergence movement that follows the saccadic component of the response to the Müller paradigm.
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Affiliation(s)
- R Bhidayasiri
- Veterans Affairs Medical Center and Case Western Reserve University, Cleveland, OH, USA
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25
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Vukelic D, Bozinovic D, Morovic M, Tesovic G, Ruzic Sabljic E, Barisic N, Knezovic I. Opsoclonus-myoclonus syndrome in a child with neuroborreliosis. J Infect 2000; 40:189-91. [PMID: 10841099 DOI: 10.1016/s0163-4453(00)80016-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Opsoclonus-myoclonus is a rare neurological syndrome affecting children and adults. In children it occurs as a parainfectious process or a paraneoplastic syndrome in association with neuroblastoma. Here we report it presenting as an unusual neurological manifestation of Lyme borreliosis. To our knowledge, this is the first report which describes recovery from this syndrome in a child.
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Affiliation(s)
- D Vukelic
- University Hospital for Infectious Diseases, dr F. Mihaljević, Zagreb, Croatia
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