Abstract Details

Title Paraneoplastic Opsoclonus-Myoclonus Syndrome and Prostate Cancer: First Reported Case

Topic Neuro-oncology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-003

Objective To describe the first reported case of Paraneoplastic Opsoclonus-Myoclonus Syndrome (OMS) in Prostate Cancer.

Background OMS is a rare movement disorder with rapid spontaneous multidirectional eye movements, involuntary muscle contractions, ataxia and dysarthria. OMS is associated with viral etiologies and malignancy. Associations with small cell lung cancer, breast cancer, melanoma, gynecological malignancies and bladder cancer have been described.

Design/Methods NA

Results CASE: A 62 year old male presented two months following diagnosis of prostate cancer with stiffness of his right leg and “tremors” of his left ear. He developed uncontrolled “tremors” of his extremities 48 hours after radical prostatectomy with positive tumor margins. He denied weakness, confusion, incontinence, seizures or loss of consciousness. Carbamazepine initiated for symptomatic improvement, resulted in transient, severe, reversible thrombocytopenia. The patient presented three weeks following radical prostatectomy with falls, unsteady gait and uncontrolled tremors. He was awake, alert, anxious, and exhibited cerebellar scanning speech. Fading petechiae were noted on bilateral feet and ankles. Neurological examination revealed opsoclonus, dysarthria and intention myoclonic limb movements. Cranial nerve exam, sensory exam and deep tendon reflexes were symmetric and intact. There was no dysautonomia, muscle wasting or encephalopathy. Laboratory studies revealed transient thrombocytopenia of 9000 that recovered upon discontinuation of carbamazepine. CSF studies and chest x-ray were normal. MRI of the spine/brain demonstrated chronic small vessel ischemic changes. Paraneoplastic OMS was diagnosed on clinical grounds. Multimodality immunosuppressive therapy and Androgen Deprivation Therapy were initiated with partial response.

Conclusions Paraneoplastic OMS is reported in 20-40% of adult cases.Autoimmunity is the perceived trigger. Studies in children with OMS reveal a high incidence of antibodies against cerebellar Purkinje cells and cerebellar granular neurons. Neurological prognosis improves with prompt treatment of the underlying malignancy. Symptom relapse and residual ataxic gait occur more commonly in older adults.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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Abstract Details