Clinical features and outcomes of opsoclonus myoclonus ataxia syndrome


YILDIRIM M., Oncel I., BEKTAŞ Ö., Tanali G., Sahin S., Kutluk T., ...More

EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY, vol.41, pp.19-26, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 41
  • Publication Date: 2022
  • Doi Number: 10.1016/j.ejpn.2022.09.002
  • Journal Name: EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
  • Page Numbers: pp.19-26
  • Keywords: Opsoclonus myoclonus ataxia syndrome, Children, Rituximab, Parainfectious, Paraneoplastic, Acute lymphoblastic leukemia, GLUTAMIC-ACID DECARBOXYLASE, INTRAVENOUS IMMUNOGLOBULIN, NEUROBLASTOMA, DIAGNOSIS, CHILDREN, RITUXIMAB, CHEMOTHERAPY, MANAGEMENT, ERA
  • Hacettepe University Affiliated: Yes

Abstract

Objectives and methods: Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare neuroinflammatory disorder. We aimed to retrospectively evaluate clinical and laboratory data and outcomes of 23 children diagnosed with OMAS in two children's hospitals between 2010 and 2021.Results: There were 14 boys and 9 girls aged 4-113 months, median 24 months. Ten (43.5%) children had paraneoplastic causes: neuroblastoma/ganglioneuroblastoma (n = 9), acute lymphoblastic leukemia (n = 1). Three children had a postinfectious cause (upper respiratory tract infection in 2, EBV infection in 1) and two had a history of vaccination (varicella in 1, hepatitis A and meningococcal in 1). No underlying factor was identified in 8 (34.8%) children. Speech disorders were more frequent in patients with neural tumors than in those without (p = 0.017). Intravenous immunoglobulin and steroids were effective as initial treatment in most children. Rituximab resulted in at least mild improvement in all 6 children with persistent or recurrent symptoms. Nine (39%) children experienced at least one relapse. Neurological sequelae were detected in 13 (57%) children. There was no significant correlation between clinical characteristics and outcome, except for higher risk of relapse in case of incomplete recovery after first attack (p = 0.001).Conclusions: Acute lymphoblastic leukemia, vaccines against hepatitis A and meningococci can be included among antecedent factors in OMAS. Among clinical symptoms, speech problems might point to the likelihood of an underlying neoplasm in OMAS. Intravenous immunoglobulin and steroids may be chosen for initial treatment while rituximab can increase the chance of recovery in case of persistent or recurrent symptoms. The presence of relapse was associated with poor outcome.