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September 2010

Anxiety as Initial Diagnosis in Opsoclonus Myoclonus Syndrome—Reply

Author Affiliations

Author Affiliations: Department of Clinical Neurosciences, Division of Neurology, University Hospital of Geneva, Geneva, Switzerland.

Arch Neurol. 2010;67(9):1155. doi:10.1001/archneurol.2010.193

In reply

Korn-Lubetzki et al have described the case of a young woman who presented with OMS preceded by psychiatric symptoms diagnosed as severe anxiety. Findings of oncologic evaluation were negative, the cerebrospinal fluid protein level was elevated, and antistreptolysin O titer was high; however, the authors have not mentioned whether anti-NMDAR or any other antibodies related to OMS have been identified in the serum/cerebrospinal fluid of their patient. The clinical course is also different from that of our patient, who presented with symptoms of depression and psychomotor slowing, gait instability, and OMS followed by the typical phases of anti–NMDA receptor encephalitis (akinetic, hyperkinetic, and then slow recovery). Their patient also had a dramatic improvement with intravenous immunoglobulin therapy. Despite differences in the possible etiology, the case described by the authors illustrates well the importance of recognizing OMS in possible paraneoplastic, postinfectious, or autoimmune etiologies. In most cases, this justifies early treatment with intravenous immunoglobulin.1

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