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Treatment of opsoclonus-myoclonus with highdose intravenous immunoglobulin

Opsoclonus-myoclonus (OM) is a neuro-ophthalmic disorder thought to involve a disturbance in olivo-tecto-cerebellar pathways. [1] Symptoms and signs range from mild polymyoclonia and nystagmus to severe oscillopsia, opsoclonus, and truncal ataxia. In infants, OM may be a paraneoplastic phenomenon and should trigger a search for an underlying neuroblastoma; [2] ACTH treatment after tumor removal has been of relative symptomatic benefit in this age group. [3] In adults, OM may be a manifestation of posterior fossa strokes and tumors, in this age group, paraneoplastic OM frequently progresses to become a chronic disorder. When a clear etiology is not encountered and the spinal fluid shows a pleocytosis, a postinfectious autoimmune mechanism should be considered. Administration of ACTH is also considered when a paraneoplastic etiology is suspected in adult patients. Harada et al [4] reported successful treatment with reserpine, but case-control trials are not performed easily in this uncommon disorder. We found no information on the role …