posted
I had this when I was in the epilepsy monitoring unit hospitalized in Rochester MN, Mayo's hospital.(Before I was properly diagnosed with Lyme.) "Hmm, that's weird," said the neurologist.
Department of Ophthalmology and Vision Sciences, University of Toronto and Hospital For Sick Children, Toronto, Ontario, Canada.
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.
PMID: 17215685 [PubMed - in process]
-------------------- **Eat Chocolate** Posts: 942 | From USA | Registered: Mar 2005
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Opsoclonus-myoclonus as a manifestation of Lyme disease.
* Peter L, Jung J, Tilikete C, Ryvlin P, Mauguiere F.
Service de Neurologie et d'Epileptologie, Hopital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France. [email protected]
Opsoclonus-myoclonus syndrome (OMS) is a rare condition that includes chaotic multidirectional saccadic eye movements associated with myoclonus and ataxia. In adults, it is usually considered to be an autoimmune disease occurring either in a paraneoplastic context or after central nervous system infection.
We report the case of a patient who presented with the classic features of OMS as a manifestation of acute Borrelia burgdorferi infection that was shown both on serum and cerebrospinal fluid examination. The outcome was favourable after prolonged antibiotic treatment.
Lyme disease could be added to the list of aetiologies to be screened in OMS, as it would allow effective treatment and avoidance of unnecessary investigations.
PMID: 16914760 [PubMed - indexed for MEDLINE]
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Opsoclonus-myoclonus syndrome in a child with neuroborreliosis. * Vukelic D, Bozinovic D, Morovic M, Tesovic G, Ruzic Sabljic E, Barisic N, * Knezovic I.
University Hospital for Infectious Diseases, dr F. Mihaljevic, Zagreb, Croatia.
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.
PMID: 10841099 [PubMed - indexed for MEDLINE]
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posted
Opsoclonus is a neurological condition where the eyes go back and forth in multiple directions very rapidly.
Opsoclonus myoclonus involves myoclonus movements of the body as well. It is supposedly a very rare condition, affecting as few as 1 in 10,000,000 people per year, more often involving children. It accompanies a tumor called neuroblastoma about 50% of the time according to the literature. It has also been thought to be a result of something post viral, and many are given steroids for it.
The information I posted above shows that Central Nervous System infections such as Lyme disease should be considered as differential diagnosis for Opsoclonus myoclonus. It mentions possible damage to the brainstem. I have documented MRI lesion on the brainstem from Lyme disease.
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AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
Before you explained it, I had to look it up.
I think it's sad that, even in a lot of the Neurological information out there, Lyme is not yet mentioned as a possible cause.
Even sadder for those with Lyme, it seems steroids and immunesuppressants would likely be the first thought of treatment.
Good find, Ima!
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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