Challenges in Diagnosing Opsoclonus-Myoclonus Syndrome in Adults

Opsoclonus-myoclonus syndrome (OMS) is a rare neurological condition characterised by uncontrolled eye movements and myoclonus. The pathophysiology is autoimmune, usually due to a paraneoplastic or parainfectious cause. Studies on adult-onset OMS are not extensive, and the lack of awareness contributes to the challenge of its diagnosis. A 37-year-old female presented with nausea, dizziness, chaotic eye movements, and wide gait. Blood tests and imaging were unremarkable, but positive oligoclonal bands and elevated protein were seen in the cerebrospinal fluid analysis. She received betahistine and ondansetron as symptomatic treatment and was diagnosed with OMS. She was treated with intravenous immunoglobulin and had a slow, incomplete recovery with residual uncontrolled eye movements. A month before her presentation, she had been seen by the General Practitioner, was treated with antiemetics, and was referred to ENT. This case illustrates the importance of awareness of OMS in avoiding delay in diagnosis.