This condition, also called opsoclonus-myoclonus-ataxia syndrome (OMAS), is rare and serious. It causes repeated, random, and fast eye movements, along with shock-like muscle spasms and trouble walking. These symptoms are often joined by a lack of coordination.

OMAS usually affects young children, often because of neuroblastoma cancer or a viral infection. In adults, it can also be linked to cancer or happen for unknown reasons. But, no matter the cause, the key to treating this syndrome is fast and strong therapy. The aim is to fully heal the brain and nerve damage.

This article explores the best medical and therapeutic approaches for OMAS. It includes the newest discoveries, how it’s diagnosed, and what new treatments are available. With proper care and a team of specialists, people with OMAS can see big improvements in their health and life.

Understanding Opsoclonus Myoclonus Syndrome

Symptoms and Signs

Opsoclonus myoclonus syndrome (OMS) has key features. These include fast, random eye movements in many directions. It also involves a shaky walk or not being able to walk (ataxia).

Other aspects of OMS are quick and sudden muscle movements (myoclonus). People with OMS might also have a hard time using their hands because of tremors. They often experience trouble sleeping, extreme irritability, and uncontrollable crying. Loss of the ability to speak is another common issue. Low muscle tone and throwing up may also happen.

Causes and Affected Populations

The leading cause of OMS in kids is paraneoplastic, linked to hidden tumors. These tumors are usually not in the brain but in the chest or stomach. A large percentage of kids with OMS have a specific tumor type (neuroblastoma or ganglioneuroblastoma).

For some, OMS is linked to unknown causes or certain viruses. It’s a rare condition, affecting about 1 in a million people all over the world. While it mainly impacts infants and young children, it can also affect adults. Girls seem to get it more often than boys.

opsoclonus myoclonus syndrome symptoms

Diagnostic Approach

The key to diagnosing opsoclonus myoclonus syndrome (OMAS) is in the details of the history. There’s no single test to prove it. The main signs are the fast, jerky eye movements (opsoclonus), sudden muscle jerks (myoclonus), and trouble walking. If a child or adult has these signs, especially with being more upset than usual, it points to OMAS.

Imaging Studies

If a doctor thinks a child might have opsoclonus myoclonus syndrome due to a tumor, they will order special scans. This could be a CT scan or an MRI. For adults with OMAS, a PET scan is usually done to check for hidden tumors.

Laboratory Tests

Doctors will do some standard tests to rule out infections. They might also check the cerebrospinal fluid (CSF) for a detailed study. This includes looking for specific bands and certain types of cells in the CSF. Sometimes, special tests can show certain antibodies, but they’re not used often since they can be expensive. They’re mostly done if the case is very unusual.

opsoclonus myoclonus syndrome diagnosis

Standard Treatment Protocols

If doctors find a tumor, they usually remove it through surgery. Tumors in young children with opsoclonus myoclonus syndrome (OMAS) are often low-stage. This means they are at an early stage, like neuroblastomas or ganglioneuroblastomas (stage I or II).

For these children, tumor chemotherapy or radiation therapy are not usually needed. Even if the tumor is removed, it may not help with the OMAS symptoms much.

Tumor Management

Doctors aim for early and strong immunotherapy to treat OMAS. The goal is to completely stop the neurological symptoms for a long time. Treatments can last 1-2 years.

They recommend using a mix of immunotherapies right after diagnosis. In North America, a treatment with three different medicines works well. It includes pulse-dose corticosteroids or high-dose ACTH, along with IVIG and rituximab. This three-agent plan has the best results for severe OMAS cases.

Immunotherapy Strategies

Rituximab is a key part of treatment for OMAS. It targets certain B cells and has been shown to help a lot. After this treatment, 80-90% of patients get better. Yet, some might need more treatment or slow removal of immunotherapies to keep getting better.

opsoclonus myoclonus syndrome treatment

Emerging Therapies and Clinical Trials

Want to know about new treatments for opsoclonus myoclonus syndrome? Check out This site lists all trials in the U.S. and some private efforts. The goal is to find better ways to treat OMAS patients.

These trials give doctors info on how often OMAS happens, what treatments work, and how it’s put in categories. For example, in Japan, there are about 656-660 cases per 37 children. In the U.S., a study found how common it is in kids here.

Experts are studying why OMS happens in the first place. One study in the U.S. looked at 356 kids with OMS to see if they had tumors or not. Another study found that a mix of several treatments, including chemotherapy, can help.

opsoclonus myoclonus syndrome treatment

Some research looked at how children’s bodies react to certain treatments. They found that specific blood tests might show if a treatment will be effective. Others are studying how too much of a certain kind of treatment can affect a child’s growth.

There are also studies tracking the health of kids with OMS over time. They help doctors improve care and understand what to expect with treatment. This kind of research is key for helping OMS patients.

Role of Immunosuppression

Immunosuppressive therapies are key in treating opsoclonus myoclonus syndrome (OMS). They help achieve long-term neurological remission. By modulating the immune system, these therapies fight the autoimmune processes causing OMS.

Corticosteroids and ACTH

Taking daily oral corticosteroids or adrenocorticotropic hormone (ACTH) can lead to certain health issues. These include weight gain, high blood pressure, and weaker bones. For milder OMS cases, a monthly dexamethasone pulse might be just as effective as ACTH.

It’s usually best to avoid prednisolone-type oral steroids for kid cases of OMS. They’re not as helpful in treating pediatric opsoclonus myoclonus syndrome.

Intravenous Immunoglobulin (IVIG)

IVIG plays a vital role in treating opsoclonus myoclonus syndrome. In North America, it’s often part of a three-drug treatment. This method successfully adjusts the immune system, improving patient symptoms and outcomes.

Rituximab and Other Monoclonal Antibodies

Rituximab is a monoclonal antibody important for treating OMS in North America. It targets specific B cells. By removing harmful B cells, rituximab helps to put and keep OMS in remission. Researchers are studying other monoclonal antibodies for their potential against this disorder.

opsoclonus myoclonus syndrome treatment

Opsoclonus Myoclonus Syndrome in Children

Opsoclonus myoclonus syndrome (OMS) can occur in children with different causes. It’s essential to understand these causes to provide the best treatment and outcomes.

Paraneoplastic Etiology

About 50-80% of young children with OMS have tumors. These tumors are usually not very harmful, unlike those in adults. This difference is important to note.

Idiopathic and Post-Viral Cases

For some children, OMS is labeled ‘idiopathic’. This means doctors don’t know the exact cause. It might also be linked to viral infections. But, sometimes the tumor causing it can disappear on its own.

Neurodevelopmental Outcomes

If OMS starts in the first two years of life, it can seriously affect speech and language. It might also lead to lasting issues like not being able to focus well or low IQ. Some children might face problems like ADHD or OCD.

Opsoclonus Myoclonus Syndrome in Adults

Opsoclonus myoclonus syndrome (OMS) isn’t just for kids. Adults can get it too. In grown-ups, it’s often tied to lung or breast cancer. This is known as a paraneoplastic cause.

Unlike in kids, where these tumors are usually not very harmful, in adults they might spread more and can be cancerous. So, in adults with OMS, the reasons behind it are more serious.

Paraneoplastic Associations

In adults, OMS is more linked to cancers of the lungs or breasts. These cancers can be more severe and have a higher chance of spreading. This is unlike what’s usually seen in kids with OMS.

Idiopathic Cases

For older kids and teens, it’s often a viral infection that triggers OMS. Yet, in some adults, the cause remains a mystery. Doctors then label it as idiopathic, meaning they can’t find a clear reason.

opsoclonus myoclonus syndrome in adults

Prognosis and Long-Term Management

In kids with opsoclonus myoclonus syndrome, the outlook isn’t always great if they only get basic treatment. About 50-75% of them see their condition coming back. But, starting with strong treatments at the beginning makes things better. To keep them doing well, they might need extra treatment for 1-2 years or more, then a slow decrease in those treatments.

Relapse Prevention

Doctors improve children’s chances by using many treatments together from the start. This can lower the chance of the problem returning. So, it’s key to act quickly and firmly to help kids stay well and avoid relapses.

Supportive Care

Some kids with opsoclonus myoclonus might face tough emotional and behavioral issues like sadness, not listening, or anger. But, with the right care and talk therapy, they can feel better. Also, parents of very sick children might find it hard to see them as kids who can do well. For them, counseling can guide how to best help their child grow and learn.


Neuroinflammation and Biomarkers

Diagnosing opsoclonus myoclonus syndrome (OMS) needs a detailed method. This includes looking for neuroinflammation. A spinal tap is key to check the cerebrospinal fluid (CSF) for inflammation signs. In this process, doctors can find certain biomarkers. These help in the OMS diagnosis.

Role of CSF Analysis

CSF analysis shows if there are oligoclonal bands present. These point to more B cells making antibodies in the central nervous system. Also, testing CSF for CD19+ B cells highlights opsoclonus myoclonus syndrome activity levels.

Autoantibody Testing

In certain cases of opsoclonus myoclonus syndrome, autoantibodies have been found. But, general autoantibody tests may not be the first choice for routine checks due to cost. It’s better to use such tests when the case seems atypical or when the initial diagnosis isn’t clear.

Opsoclonus Myoclonus Syndrome and Neuroblastoma

The link between opsoclonus myoclonus syndrome (OMAS) and neuroblastoma (NB) is complex but important to understand. OMAS is often connected to hidden stages of NB, seen in about half of cases. Roughly 2-3% of children with NB will show the severe OMAS symptoms too.

Tumor Staging and Risk Stratification

Children with OMAS usually have lower stage NBs or ganglioneuroblastomas, falling under stages I or II. Properly staging and risk assessing these tumors is crucial. It helps doctors pick the best treatments. These treatments aim to tackle both the NB and OMAS together.

Treatment Approaches for Neuroblastoma

In cases involving OMAS and NB, children typically avoid aggressive chemo or radiation. Instead, doctors opt for removing the tumor surgically. However, just removing the tumor might not fix the OMAS symptoms. A mix of tumor care and immunotherapies is often needed for the best outcomes.

Multidisciplinary Care Team

Efficiently handling opsoclonus myoclonus syndrome means collaborating with a wide team. This team involves many experts like neurologists, oncologists, and more. They focus on giving holistic care to better the patient’s life. They work together to tackle the various health, personal, and social issues related to this rare disorder.

Neurologists are key in spotting and creating a plan to treat opsoclonus myoclonus syndrome. Oncologists step in if a tumor, like in neuroblastoma, is the cause. In these cases, oncologists and other doctors help with treatments that fight the immune system’s wrong responses.

Therapists help patients with their movement, coordination, and speaking struggles linked to opsoclonus myoclonus syndrome. They provide exercises and therapy to boost the patient’s skills and wellbeing. Nurses, psychologists, and social workers can also join the team. They offer extra support and information to the patient and their relatives.

With this group of specialists working together, they can design a specific treatment for each patient. This patient-focused approach improves their chances of getting better and having a positive long-term health outlook.

Opsoclonus Myoclonus Syndrome in COVID-19

New studies show a possible link between opsoclonus myoclonus syndrome (OMAS) and COVID-19. After getting infected with SARS-CoV-2, some adults develop OMAS. In a review from 2021, 51 cases of myoclonus or ataxia were found in COVID-19 patients. Most were men and their average age was around 60.

The review noted that myoclonus could happen alone, with ataxia, or with cognitive changes, all within a month of COVID-19 symptoms. Chest scans of these patients highlighted common COVID-19 patterns. These included certain lung issues like ground-glass opacities and severe lung damage.

Most people with mild to moderate COVID-19 who later developed OMAS got better within 2 months. They improved with or without special treatment. This indicates that OMAS from COVID-19 usually follows a mild, self-resolving path.

Scientists are still looking into how COVID-19 might trigger opsoclonus myoclonus syndrome. Figuring this out could help manage OMAS better. It might also offer key details on how this rare neurological condition fits into the bigger COVID-19 picture.

Paraneoplastic Opsoclonus Myoclonus Syndrome

Tumor Types

Paraneoplastic opsoclonus myoclonus syndrome (POMS) is linked more often to lung or breast cancers in adults. This is different from the cases in young children, where neuroblastomas are more common. Adult tumors tend to spread more and are more aggressive than those seen in kids.

Diagnostic Workup

For adults suspected of having POMS, a detailed diagnostic workup is needed. This includes tests like PET scanning to find any hidden tumors. This step is vital since POMS is mainly tied to these cancer types in adults.


Opsoclonus myoclonus syndrome is rare and affects the nervous system. It’s crucial to start strong treatment early, especially for kids. A team of healthcare experts should work together. This helps make sure patients get the best care and support they need. New treatments are still being researched to help people with opsoclonus myoclonus syndrome.

The exact causes of this syndrome are not entirely known. But we have advanced in understanding it. We also know better ways to treat it. A team that focuses on the patient can really make a difference. They help in getting the best results for people with this challenge.

Research is ongoing and will lead to better treatments for this syndrome. This brings a brighter future for those with the condition. Learning more and combining different areas of care is key. It helps patients and their families deal with this issue better and stronger.


What is opsoclonus-myoclonus-ataxia syndrome (OMAS)?

OMAS is a rare disorder that affects the nervous system. It causes rapid and uncontrolled eye movements, balance problems, muscle spasms, and trouble talking. This disorder can get in the way of daily activities and life.

What are the key symptoms of OMAS?

The main symptoms of OMAS are fast, uncontrollable eye movements and trouble with balance. Patients may also experience sudden muscle spasms and have issues with their sleep and behavior. Speaking may become hard as well.

What are the common causes of OMAS?

In kids, OMAS is often linked to tumors, like neuroblastoma, or can happen without a known cause. It can also be triggered by different viruses. Adults might see it linked to more serious cancers in the lungs or breasts.

How is OMAS diagnosed?

Doctors diagnose OMAS by looking at its common symptoms. They might also do tests like brain scans, examining the fluid around the brain, and checking for certain antibodies in the body.

What is the standard treatment approach for OMAS?

The main goal in treating OMAS is to start powerful immune treatments early. These treatments often include drugs like corticosteroids, IVIG, and rituximab. The aim is to put the disorder into a deep remission.

How does OMAS affect children differently than adults?

Children with OMAS are often linked to less serious tumors. These tumors can be inactive. For adults, OMAS is typically seen with more severe cancers that might have spread further.

What is the prognosis for OMAS patients?

The outcome for someone with OMAS depends on several factors. How old they are, what caused the OMAS, and how well they respond to treatment matters. Early and strong treatment is key to avoiding long-term brain and development problems.

Can OMAS occur in the context of COVID-19 infection?

Yes, some COVID-19 patients have reported symptoms like those in OMAS. Researchers are still studying if there’s a direct link between COVID-19 and OMAS.

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