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Jimenez Giraldo S, Michaelis M, Kerr L, Cortina C, Zhang B, Gorman MP. Inaugural Patient-Reported Registry of Pediatric Opsoclonus-Myoclonus-Ataxia Syndrome: Presentation, Diagnosis, and Treatment of 194 Patients. Pediatr Neurol 2024; 158:128-134. [PMID: 39042987 DOI: 10.1016/j.pediatrneurol.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/28/2024] [Accepted: 06/16/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare neuroimmune disease with peak onset at 18 months, associated with neural crest tumors in 50% of patients. In part due to its rarity, misdiagnosis at onset is common, can delay treatment, and may contribute to adverse outcomes. Patient-reported registries may overcome some of these challenges in rare disease research. In this context, the OMSLife Foundation collaborated with the National Organization of Rare Diseases to create a patient-reported registry in OMAS. METHODS Retrospective analysis was performed of data entered by parents of patients with OMAS into nine online surveys assessing demographics, symptoms at onset, triggers, time of diagnosis, treatment, and additional therapies. RESULTS A total of 194 patients were enrolled. There was a female predominance (54%) and high rate of parental autoimmunity (31%). Age at onset peaked between 12 and 18 months overall. The age of onset was older in female patients (median [interquartile range]: females 22 [15 to 31] vs males 18 [14 to 23], P = 0.0223, P = 0.0223). Symptoms at onset most commonly included ataxia (84%) and were typically severe. Initial misdiagnosis occurred in nearly 50% and tumor discovery was delayed in 18 patients, but overall median time to correct diagnosis was 25 days. Most patients (56%) received combination immunomodulatory therapies, and nearly all underwent supportive therapies. CONCLUSIONS Patient- and parent-powered research is feasible in OMAS and created the second largest published cohort of pediatric patients with OMAS. Results were similar to other large cohorts and also validated findings from prior case reports and smaller case series.
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Affiliation(s)
- Sandra Jimenez Giraldo
- Division of Child Neurology, Department of Pediatrics, Hasbro Children's Hospital, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | | | - Lauren Kerr
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Cortina
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Norrito RL, Puleo MG, Pintus C, Basso MG, Rizzo G, Di Chiara T, Di Raimondo D, Parrinello G, Tuttolomondo A. Paraneoplastic Cerebellar Degeneration Associated with Breast Cancer: A Case Report and a Narrative Review. Brain Sci 2024; 14:176. [PMID: 38391750 PMCID: PMC10887192 DOI: 10.3390/brainsci14020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Paraneoplastic neurological syndromes (PNSs) are an uncommon complication of cancer, affecting nearby 1/10,000 subjects with a tumour. PNSs can involve all the central and peripheral nervous systems, the muscular system, and the neuromuscular junction, causing extremely variable symptomatology. The diagnosis of the paraneoplastic disease usually precedes the clinical manifestations of cancer, making an immediate recognition of the pathology crucial to obtain a better prognosis. PNSs are autoimmune diseases caused by the expression of common antigens by the tumour and the nervous system. Specific antibodies can help clinicians diagnose them, but unfortunately, they are not always detectable. Immunosuppressive therapy and the treatment of cancer are the cornerstones of therapy for PNSs. This paper reports a case of PNSs associated with breast tumours and focuses on the most common paraneoplastic neurological syndromes. We report a case of a young female with a clinical syndrome of the occurrence of rigidity in the right lower limb with postural instability with walking supported and diplopia, with a final diagnosis of paraneoplastic cerebellar degeneration and seronegative rigid human syndrome associated with infiltrating ductal carcinoma of the breast.
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Affiliation(s)
- Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Puleo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Chiara Pintus
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Maria Grazia Basso
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Giuliana Rizzo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Tiziana Di Chiara
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Domenico Di Raimondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Gaspare Parrinello
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy
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Santoro JD, Kerr LM, Codden R, Casper TC, Greenberg BM, Waubant E, Kong SW, Mandl KD, Gorman MP. Increased Prevalence of Familial Autoimmune Disease in Children With Opsoclonus-Myoclonus Syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1079. [PMID: 34475249 PMCID: PMC8422990 DOI: 10.1212/nxi.0000000000001079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives Opsoclonus-myoclonus syndrome (OMS) is a rare autoimmune disorder associated with neuroblastoma in children, although idiopathic and postinfectious etiologies are present in children and adults. Small cohort studies in homogenous populations have revealed elevated rates of autoimmunity in family members of patients with OMS, although no differentiation between paraneoplastic and nonparaneoplastic forms has been performed. The objective of this study was to investigate the prevalence of autoimmune disease in first-degree relatives of pediatric patients with paraneoplastic and nonparaneoplastic OMS. Methods A single-center cohort study of consecutively evaluated children with OMS was performed. Parents of patients were prospectively administered surveys on familial autoimmune disease. Rates of autoimmune disease in first-degree relatives of pediatric patients with OMS were compared using Fisher exact t test and χ2 analysis: (1) between those with and without a paraneoplastic cause and (2) between healthy and disease (pediatric multiple sclerosis [MS]) controls from the United States Pediatric MS Network. Results Thirty-five patients (18 paraneoplastic, median age at onset 19.0 months; 17 idiopathic, median age at onset 25.0 months) and 68 first-degree relatives (median age 41.9 years) were enrolled. One patient developed systemic lupus erythematosus 7 years after OMS onset. Paraneoplastic OMS was associated with a 50% rate of autoimmune disease in a first-degree relative compared with 29% in idiopathic OMS (p = 0.31). The rate of first-degree relative autoimmune disease per OMS case (14/35, 40%) was higher than healthy controls (86/709, 12%; p < 0.001) and children with pediatric MS (101/495, 20%; p = 0.007). Discussion In a cohort of pediatric patients with OMS, there were elevated rates of first-degree relative autoimmune disease, with no difference in rates observed between paraneoplastic and idiopathic etiologies, suggesting an autoimmune genetic contribution to the development of OMS in children.
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Affiliation(s)
- Jonathan D Santoro
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA.
| | - Lauren M Kerr
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Rachel Codden
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Theron Charles Casper
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Benjamin M Greenberg
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Emmanuelle Waubant
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Sek Won Kong
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Kenneth D Mandl
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
| | - Mark P Gorman
- From the Department of Neurology (J.D.S.), Massachusetts General Hospital, Boston; Department of Neurology (J.D.S., J.M.K., M.P.G.), Boston Children's Hospital, MA; Harvard Medical School (J.D.S., K.D.M.), Boston, MA; Division of Neurology (J.D.S.), Department of Pediatrics, Children's Hospital of Los Angeles, CA; Department of Neurology (J.D.S.), Keck School of Medicine at the University of Southern California, Los Angeles; Department of Pediatrics (R.C., T.C.C.), University of Utah School of Medicine, Salt Lake City; Department of Neurology and Neurotherapeutics (B.M.G.), The University of Texas Southwestern Medical Center at Dallas, TX; UCSF Weill Institute for Neurosciences (E.W.), Department of Neurology, University of California San Francisco, CA; Computational Health Informatics Program (S.W.K., K.D.M.), Boston Children's Hospital, MA; and Department of Pediatrics (S.W.K., K.D.M.), Boston Children's Hospital, MA
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