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Anxiety as initial diagnosis of opsoclonus myoclonus syndrome
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Isabelle Korn-Lubetzki, MD; Bettina Steiner-Birmanns, MD; Sol Jaworowski, MD.
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Departments of Neurology (Drs Korn-Lubetzki and Birmanns) and Psychiatry (Dr
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Jaworowski), Shaare Zedek Medical Center, Jerusalem, Israel.
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Correspondence: Dr Isabelle Korn-Lubetzki, Department of Neurology, Shaare Zedek
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Medical Center, PO Box 3235, Jerusalem 91031, Israel.
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Tel: (972) 2 655 5988. Fax: (972) 2 666 6233; e-mail:
[email protected]
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Financial Disclosure: None reported
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Key words: Opsoclonus; Myoclonus; Post infectious, Anxiety
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Word count including text, title, references: 365
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Formatted: Numbering: Continuous
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We read with interest the report by Kurian et al, describing a young woman with
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opsoclonus-myoclonus syndrome (OMS) in the context of an Anti–N-Methyl-D-
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Aspartate Receptor (NMDAR) Encephalitis. 1 The clinical signs at presentation were
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speech difficulties, hypophonia, anxiety, and tremulous eye and head movement
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followed by increasing gait instability. She was diagnosed with depression and
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initially hospitalized in the psychiatric division.
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We would like to describe our related impression from a young woman with the same
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syndrome. Four months post partum, a 30 year old woman developed dizziness and
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progressive imbalance, followed by whole body tremor. She was unable to stand, sit,
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or feed herself. While she denied post partum depression, the psychiatric consultant
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diagnosed severe anxiety. Treatment with hypnosis repeatedly resulted in transient
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spectacular improvement of the tremor, later even enabling to perform a brain MRI
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initially planned under general anesthesia. Specific diagnosis was made only when the
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opsoclonus appeared, 5 days later, as the myoclonic jerks intensified. Extensive
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etiological with full oncologic workup was normal except for elevated CSF protein
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and high antistreptolysin O titers. High dose IV immunoglobulin, effective in post
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infectious cases 2, resulted in dramatic improvement.
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We want to emphasize that both young adult patients were initially diagnosed to
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suffer from a psychiatric illness. While the typical course of anti NMDAR
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encephalitis is the appearance of psychiatric symptoms followed by a decreased level
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of consciousness, neither Kurian’s patient nor ours had other psychiatric symptoms at
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presentation than severe anxiety.
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Most of the cases of opsoclonus myoclonus syndrome are diagnosed in children when
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symptoms have been present for several weeks. 3Acute and florid presentation, rare in
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adults, has to be recognized in order to start treatment as soon as possible.
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References
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1. Kurian M, Lalive PH, Dalmau JO, Horvath J. Opsoclonus-myoclonus syndrome in
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anti-N-methyl-D-aspartate receptor encephalitis. Arch Neurol. 2010;67 (1):118-121.
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2. Glatz K, Meinck HM, Wildemann B. Parainfectious opsoclonus-myoclonus
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syndrome: high dose intravenous immunoglobulins are effective. J Neurol Neurosurg
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Psychiatry. 2003;74 (2): 279-280.
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3. Haden SV, McShane MA, Holt CM. Opsoclonus myoclonus: a non-epileptic
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movement disorder that may present as status epilepticus. Arch Dis Child. 2009;94
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(11):897–899
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