Parkinsonism and Related Disorders
journal homepage: https://www.journals.elsevier.com/parkinsonism-and-related-disorders
Letter to the Editor
1. Introduction
Opsoclonus-Myoclonus Syndrome (OMS) is a rare neurologic
condition comprised of the two hallmark signs of dysmetric ocular
ataxia and myoclonic jerks of the extremities. The eye movements
have been described as ‘‘dancing eyes’’. The eyes dart involuntarily
away from the point of visual fixation or pursuit in a manner that
can be considered a myoclonic jerk of the extra-ocular muscles.
When the patient attempts to align the gaze on a point, there may
be dysmetric overshoot of the eyemovement.Myoclonicmovements
of the extremities occur at rest, and intended actions are ataxic. The
mean age of presentation of OMS in childhood is 14 months, and it
presents as a paraneoplastic syndromeassociated with an underlying
tumor in 50–60% of the cases [1,2], most commonly neuroblastoma
or ganglioneuroblastoma. Recent research has revealed the presence
of several auto-antibodies including anti-Hu, anti-Ri, a-Enolase,
KSRP and NLK [3] in patients with OMS. These antibodies bind to
an array of targets in the cerebellum andmaymanifest as oligoclonal
bands in cerebrospinal fluid. The syndrome is often associated
with behavioral changes such as aggression, irritability, and
insomnia. Post-vaccine OMS is not well described in the pediatric
population.
2. Case report and discussion
The patient was a fully vaccinated and developmentally appropriate
11-year-old female with seasonal allergies and mild asthma.
Her initial symptoms consisted of a sudden onset of increased
‘‘moodiness’’ causing uncharacteristic anger and depression. These
symptoms presented approximately 15 days after receiving her first
human papilloma virus (HPV) (Gardasil) vaccination on 11/26/
2007. The uncharacteristic behavior persisted and 1 month after
the initial mood changes she noted that her ‘‘eyes were doing weird
things’’ and she perceived that visual images went ‘‘back and forth
in circles’’. The abnormal ocular movements occurred with her eyes
closed or open, and could be only minimally suppressed with great
effort. There were no other symptoms at this time, however, her eye
symptoms became more frequent and troubling to her. She then
received a second HPV vaccination 2 months later in addition to
a meningococcal (Menactra) vaccine. Four days after these vaccinations
she developed noticeable worsening of the eye movements and acute perception of dizziness, which she described as the
‘‘room is spinning.’’ This was accompanied by leg weakness
requiring assistance to walk and ‘‘jumpy arms.’’ Family history
reveals a cousin with childhood epilepsy, maternal great aunt
with lupus, maternal grandfather died of a ruptured aneurysm at
age 40, and mother with fibromyalgia, but no movement disorders
or paraneoplastic syndromes.
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