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August 2017

Opsoclonus Recorded by a Smartphone

Author Affiliations
  • 1Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
JAMA Otolaryngol Head Neck Surg. 2017;143(8):847-848. doi:10.1001/jamaoto.2017.0510

Opsoclonus is a very specific pathologic eye movement condition characterized by involuntary, chaotic, and multidirectional eye movements, with horizontal, vertical, and torsional components.1 Recently we experienced a case of idiopathic opsoclonus during an acute attack, and real-time recording of opsoclonus was performed via a smartphone.

A 39-year-old woman was well before a cough, chillness, and muscle soreness occurred on May 17, 2016. An acute vertiginous episode occurred on May 23, accompanied by vomiting, blurred vision, and unsteady gait. She was sent to emergency service, where high-frequency (15 Hz) and multi-directional dancing eye movements were observed and recorded by a smartphone in real time (Video 1). Myogenic jerks of the upper limbs were also noted. She was then admitted to the otolaryngological ward, where both cerebellar function test and magnetic resonance imaging (MRI) demonstrated nothing of note. A series of serological and immunological tests, including multiple viral titers, anti-nuclear antibody, lupus erythematosus cell preparation, complements, rheumatoid factor, and immunoelectrophoresis were performed. However, all test results were within normal limits except for elevated IgG and IgM titers for herpes simplex virus. Thus, herpes simplex virus–related infection was suspected. Methylprednisolone (40 mg, twice daily) was subsequently administered intravenously for 3 days, followed by oral prednisolone (60 mg twice daily), which was then tapered off within 1 month. Clonazepam (0.5 mg, twice daily) was also given orally for 1 month. Elimination of opsoclonus was achieved without adverse effects 1 month after treatment (Video 2).

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