In Reply We thank Drs Kim and Budhram for their valuable suggestion. Owing to the 600-word limit in the Observation section, much of the information associated with this patient had to be omitted in the article.1 Herein we fill in some of the gaps. We agree that magnetic resonance imaging is the first priority for excluding a paraneoplastic or parainfectious origin when treating a patient with opsoclonus. Small cell carcinoma of the lung, breast cancer, and ovarian cancer are most prevelent in adults with opsoclonus, whereas neuroblastoma accounts for more than 50% prevalence in children.2 Of course, such work-up had been done in this patient, yet the results were negative. Occasionally, other neoplasms (ie, non-Hodgkin’s lymphoma, malignant lymphoma) have also been related to opsoclonus.2 In addition, many parainfectious origins were proposed, namely, streptococcus, varicella-zoster virus, Epstein-Barr virus, human immunodeficiency virus (HIV), and lyme disease, for example.2
Hsu S, Young Y. Opsoclonus-Myoclonus Syndrome—Reply. JAMA Otolaryngol Head Neck Surg. 2018;144(4):388. doi:10.1001/jamaoto.2017.3400
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