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Zhu H, Wu W, Chen L, Hou C, Zeng Y, Tian Y, Shen H, Gao Y, Zhang Y, Peng B, Chen WX, Li X. Clinical Analysis of Pediatric Opsoclonus-Myoclonus Syndrome in One of the National Children's Medical Center in China. Front Neurol 2021; 12:744041. [PMID: 34690917 PMCID: PMC8531251 DOI: 10.3389/fneur.2021.744041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To study the clinical characteristics and treatment of pediatric opsoclonus-myoclonus syndrome (OMS). Methods: We analyzed the clinical data of nine children OMS between June 2017 and Nov 2020. Results: Nine children (M/F = 3:6, median onset age was 18 months) diagnosed with OMS were included in the study. Before onset, human rhinovirus and respiratory syncytial virus were seen in one patient, respectively. And one patient received Japanese encephalitis vaccination. Three patients had neuroblastoma, and one patient had ganglioneuroblastoma. All patients' symptoms were improved after receiving surgery (for four patients with tumor), intravenous human immunoglobulin and pulsed methylprednisolone. However, four patients without mass relapsed and became relapse free after rituximab treatment. The relapse rate was 44.4% (4/9). The OMS severity score at the last follow-up was significantly lower than the OMS severity score at onset (3.0 ± 1.0 vs. 11.0 ± 2.2, paired-samples t-test, P < 0.001). All patients had at least one item of neurological symptoms or neuropsychological disturbances. Conclusion: For pediatric OMS, human rhinovirus infection and respiratory syncytial virus infection can be seen before onset. Rituximab is effective in reducing relapse. Improving recognition and long-term prognosis in OMS is urgent.
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Affiliation(s)
- Haixia Zhu
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenlin Wu
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lianfeng Chen
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chi Hou
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yiru Zeng
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yang Tian
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiling Shen
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuanyuan Gao
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yani Zhang
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bingwei Peng
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen-Xiong Chen
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaojing Li
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Abstract
Human herpes virus 6 (HHV-6) infection is considered a self-limited disease in immunocompetent children. However, HHV-6 could be associated with various neurologic diseases. We describe 8 children with suspected central nervous system infection and detection of HHV-6 in cerebrospinal fluid. The clinical significance of HHV-6 detection is controversial because it may be caused by primary infection, reactivation or latency.
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Kokkali S, Oddou I, Gantzer J, Fitsiori A. Human herpesvirus 6 encephalitis in a patient treated with everolimus for renal cell carcinoma. J Oncol Pharm Pract 2020; 26:2052-2057. [PMID: 32299316 DOI: 10.1177/1078155220918022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Everolimus is a mammalian target of rapamycin inhibitor and is approved as second-line treatment or beyond for renal cell carcinoma. We report a case of a 75-year-old male treated with everolimus for metastatic renal cell carcinoma, after sunitinib treatment, who was diagnosed with human herpesvirus 6 encephalitis. CASE REPORT After 39 months of everolimus, 10 mg per day, our patient was admitted with fever, consciousness disorders and a partial epileptic crisis. Laboratory tests revealed lymphopenia (170 lymphocytes/mm3), and polymerase chain reaction in cerebrospinal fluid was positive for human herpesvirus 6. Brain magnetic resonance imaging study demonstrated hippocampal abnormality and a pontine lesion. MANAGEMENT AND OUTCOME The patient stopped everolimus treatment indefinitely. He received ganciclovir initially intravenously, with a rapid clinical improvement, as well as polyvalent immunoglobulins were given to correct hypogammaglobulinemia. Two months later, antiviral therapy was switched to oral ganciclovir, which was never stopped. A new lumbar puncture was performed one month after the initiation of antiviral treatment, which did not reveal human herpesvirus 6 DNA anymore. DISCUSSION Human herpesvirus 6 encephalitis is more common in hematopoietic stem cell transplant recipients and HIV patients. This is the first case probably associated to everolimus treatment. In contrast to most patients diagnosed with this infection, who either die or develop neurologic sequelae, our patient almost fully recovered two months later.
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Affiliation(s)
- Stefania Kokkali
- Agios Savvas General Cancer and Oncology, Hospital of Athens, Athens, Greece
| | - Isabelle Oddou
- University Hospitals Strasbourg, Strasbourg, Alsace, France
| | | | - Aikaterini Fitsiori
- Service Neuroradiologie Diagnostique et Interventionnelle, Hopitaux Universitaires de Geneve, Geneve, Switzerland
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Herrscher H, Artzner T, Coca HA, Schneider F, Proust F, Guillot M. Cerebral lymphoma presenting as a rhombencephalitis: Case report and review of the literature. Rev Neurol (Paris) 2019; 175:412-414. [PMID: 31030899 DOI: 10.1016/j.neurol.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- H Herrscher
- Service de réanimation médicale, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - T Artzner
- Service de réanimation médicale, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - H-A Coca
- Service de neurochirurgie, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - F Schneider
- Service de réanimation médicale, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - F Proust
- Service de neurochirurgie, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - M Guillot
- Service de réanimation médicale, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Simon T, Cheuret E, Fiedler L, Mengelle C, Baudou E, Deiva K. Acute transverse myelitis following an opsoclonus-myoclonus syndrome: An unusual presentation. Eur J Paediatr Neurol 2018; 22:878-881. [PMID: 29773357 DOI: 10.1016/j.ejpn.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
Opso-myoclonus syndrome (OMS) is a very rare and severe condition. Ataxia, opsoclonus, myoclonus and/or behavioral and sleeping disturbances define that autoimmune disorder syndrome which is paraneoplastic or triggered by an infection. Here, we report a 3 year-old immunocompetent boy who developed an atypical OMS which was later complicated by an acute transverse myelitis. Screening for neuroblastoma was negative and extensive infectious screening revealed an active HHV-6 infection confirmed by blood and cerebrospinal fluid PCR. A parainfectious disease was suggested and immunosuppressive treatment was initiated. After 2 years of follow-up, the patient has a left leg paresia needing a splint and is otherwise normal. Transverse myelitis can be associated with parainfectious OMS and earlier immunosuppressive treatment in these cases may be useful especially in young and immunocompetent children.
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Affiliation(s)
- Thomas Simon
- Hôpital des enfants, Pediatric Neurology Department, 330 Avenue de grande Bretagne, 31000 Toulouse, France
| | - Emmanuel Cheuret
- Hôpital des enfants, Pediatric Neurology Department, 330 Avenue de grande Bretagne, 31000 Toulouse, France
| | - Léa Fiedler
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, Pediatric Neurology Department, National Referral Center for Rare Inflammatory Brain and Spinal Diseases and Université Paris-Sud, UMR 1184-CEA-IDMIT, Center for Immunology of Viral Infections and Autoimmune Diseases, 94275, Le Kremlin Bicêtre, France
| | - Catherine Mengelle
- Hôpital Purpan, Virology Department, 330 Avenue de Grande Bretagne, 31000, Toulouse, France
| | - Eloïse Baudou
- Hôpital des enfants, Pediatric Neurology Department, 330 Avenue de grande Bretagne, 31000 Toulouse, France
| | - Kumaran Deiva
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, Pediatric Neurology Department, National Referral Center for Rare Inflammatory Brain and Spinal Diseases and Université Paris-Sud, UMR 1184-CEA-IDMIT, Center for Immunology of Viral Infections and Autoimmune Diseases, 94275, Le Kremlin Bicêtre, France.
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Paredes-Ebratt ÁM, Espinosa-García ET. Síndrome de Kinsbourne: reporte de un caso. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n1a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Blaes F, Dharmalingam B. Childhood opsoclonus-myoclonus syndrome: diagnosis and treatment. Expert Rev Neurother 2016; 16:641-8. [DOI: 10.1080/14737175.2016.1176914] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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