Contributions
Abstract: EP1316
Type: ePoster
Abstract Category: Clinical aspects of MS - 3 Paediatric MS
Introduction: Ocular flutter is an opsoclonic disorder with rapid, low-amplitude horizontal saccadic oscillations without inter-saccadic intervals. It has been described in the context of infectious diseases, drug toxicity, or paraneoplastic syndromes. The neuroanatomical region associated with ocular flutter has not been clearly defined. However, in a few cases, cerebellar or PPRF lesions have been reported. Ocular flutter has been described once in adult-onset Multiple Sclerosis (MS) during disease course. However, ocular flutter has never been reported as a presenting symptom of MS, particularly pediatric MS with positive anti-MOG antibodies.
Case report: We describe a 13 year-old girl who presented with a 5-day history of abnormal ocular movements with concomitant blurred vision and involuntary head movements. On neurological examination rapid, horizontal saccadic oscillations of low amplitude in association with mild cerebellar signs were found. Brain MRI revealed three periventricular and one subcortical non-enhancing lesion. Furthermore, oligoclonal bands and IgG index were negative. The atypical presentation and MRI findings not-fulfilling Barkhof criteria led to an original diagnosis of “opsoclonus-myoclonus”. The patient followed the protocol for malignancy and was treated with corticosteroids with good response. The search for neuroblastoma or other malignancy was negative. She remained free of symptoms for the next three years until she presented again with the same ocular oscillations without any other clinical manifestations. Brain MRI was repeated and lesions were now typical for MS. A second LP revealed oligoclonal bands in CSF. A diagnosis of MS was made. Further investigations included positive serum anti-MOG antibodies and negative antibodies to antigen of neural receptors and glial cells.
Conclusions: Ocular flutter is an extremely rare clinical manifestation of MS that can be the presenting feature of the disease. The presence of positive anti-MOG antibodies, which is found in a minority of pediatric MS cases, is a further interesting observation.
Disclosure:
M. Breza reports no conflict of interest.
C. Kotsalis reports no conflict of interest.
N. Smyrni reports no conflict of interest.
G. Koutsis has received research grants from Genesis Pharma and Teva, consultation fees, advisory boards and honoraria from Genzyme, Genesis Pharma, Teva and Novartis
E. Anagnostou reports no conflict of interest.
J. Tzartos has shares in a diagnostic laboratory (Tzartos Neurodiagnostics) in Athens.
C. Kokkinis reports no conflict of interest.
C. Kilindireas received research grants from Biogen, Novartis, Teva, and Merck-Serono.
A. Papavasiliou reports no conflict of interest.
Abstract: EP1316
Type: ePoster
Abstract Category: Clinical aspects of MS - 3 Paediatric MS
Introduction: Ocular flutter is an opsoclonic disorder with rapid, low-amplitude horizontal saccadic oscillations without inter-saccadic intervals. It has been described in the context of infectious diseases, drug toxicity, or paraneoplastic syndromes. The neuroanatomical region associated with ocular flutter has not been clearly defined. However, in a few cases, cerebellar or PPRF lesions have been reported. Ocular flutter has been described once in adult-onset Multiple Sclerosis (MS) during disease course. However, ocular flutter has never been reported as a presenting symptom of MS, particularly pediatric MS with positive anti-MOG antibodies.
Case report: We describe a 13 year-old girl who presented with a 5-day history of abnormal ocular movements with concomitant blurred vision and involuntary head movements. On neurological examination rapid, horizontal saccadic oscillations of low amplitude in association with mild cerebellar signs were found. Brain MRI revealed three periventricular and one subcortical non-enhancing lesion. Furthermore, oligoclonal bands and IgG index were negative. The atypical presentation and MRI findings not-fulfilling Barkhof criteria led to an original diagnosis of “opsoclonus-myoclonus”. The patient followed the protocol for malignancy and was treated with corticosteroids with good response. The search for neuroblastoma or other malignancy was negative. She remained free of symptoms for the next three years until she presented again with the same ocular oscillations without any other clinical manifestations. Brain MRI was repeated and lesions were now typical for MS. A second LP revealed oligoclonal bands in CSF. A diagnosis of MS was made. Further investigations included positive serum anti-MOG antibodies and negative antibodies to antigen of neural receptors and glial cells.
Conclusions: Ocular flutter is an extremely rare clinical manifestation of MS that can be the presenting feature of the disease. The presence of positive anti-MOG antibodies, which is found in a minority of pediatric MS cases, is a further interesting observation.
Disclosure:
M. Breza reports no conflict of interest.
C. Kotsalis reports no conflict of interest.
N. Smyrni reports no conflict of interest.
G. Koutsis has received research grants from Genesis Pharma and Teva, consultation fees, advisory boards and honoraria from Genzyme, Genesis Pharma, Teva and Novartis
E. Anagnostou reports no conflict of interest.
J. Tzartos has shares in a diagnostic laboratory (Tzartos Neurodiagnostics) in Athens.
C. Kokkinis reports no conflict of interest.
C. Kilindireas received research grants from Biogen, Novartis, Teva, and Merck-Serono.
A. Papavasiliou reports no conflict of interest.