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Título

OPSOCLONUS-MIOCLONUS-ATAXIA SYNDROME AS FIRST CLINICAL PRESENTATION OF MECP2 MUTATION: A CASE REPORT

Apresentação do caso

A one year seven months old female that was hospitalized in our tertiary reference service with a history of fever, tremor, trunk and gait instability, vomit and irritability for 20 days. At day four in our hospital, she evolved with myoclonia and eye movements that got worst by day seven, pointing for the diagnosis of opsoclonus-myoclonus-ataxia syndrome (OMAS). Patient was born prematurely at 32 weeks, and had motor and speech delay. At corrected age of one year and five months, she could walk with support and had limited monosyllabic vocabulary. She did not have any history of hand shaking, other stereotypes or seizures. Her head circumference was normal. After she presented neurodevelopmental regression with important gait and trunk instability until gait loss. The patient was extensively investigated with tumoral, serology, inflammatory and autoimmune markers, electroencephalogram, metabolic screening and neuroimaging. All tests without suggestives abnormalities of a specific underlying pathology. We’ve had collected the genetic test - panel, evidencing a pathogenic MECP2 heterozygous mutation.

Discussão

OMAS is a rare neurologic disorder that presents with a combination of characteristic eye movements and myoclonus in addition to ataxia, irritability and sleep disturbance. Typically affects children and often arises as a paraneoplasic phenomenon in children who present with neuroblastoma and related tumors. In addition to the movement disorders often seen in OMAS, developmental stagnation, regression, and alterations in sleep and mood can occur. MECP2 mutation and Rett syndrome are a commom genetic disorder, typically affecting females with clinical and neurophatological findings, indicating early developmental arrest. There is no previous data base relating OMAS and MECP2 mutation. Movement disorders are frequently related to MECP2 mutation, such as stereotypies, gait abnormalities, broad-based or ataxic gait, spasticity, dystonia, tremor, myoclonus, bruxism, ataxia, choreoathetoid movements and rigidity, but none OMAS relation was previously reported.

Comentários finais

Movement disorders are common in patients with MECP2 mutations. They typically have motor stereotypies, developmental arrest, microcephaly and epilepsy. OMAS often arises as a paraneoplasic disease. Since our patient did not have any evidence of underlaying tumors, stereotypies, microcephaly or seizures, the case report gait us to a new atipical Rett Syndrome presentation or to a overlap of both pathologies.

Referências (se houver)

1. Rossor T, Yeh EA, Khakoo Y, Angelini P, Hemingway C, Irani SR, Schleiermacher G, Santosh P, Lotze T, Dale RC, Deiva K, Hero B, Klein A, de Alarcon P, Gorman MP, Mitchell WG, Lim M; OMS Study Group. Diagnosis and Management of Opsoclonus-Myoclonus-Ataxia Syndrome in Children: An International Perspective. Neurol Neuroimmunol Neuroinflamm. 2022 Mar 8;9(3):e1153. doi: 10.1212/NXI.0000000000001153. PMID: 35260471; PMCID: PMC8906188.

2. Blaes F, Dharmalingam B. Childhood opsoclonus-myoclonus syndrome: diagnosis and treatment. Expert Rev Neurother. 2016 Jun;16(6):641-8. doi: 10.1080/14737175.2016.1176914. Epub 2016 Apr 27. PMID: 27095464.

3. Brunetti S, Lumsden DE. Rett Syndrome as a movement and motor disorder - A narrative review. Eur J Paediatr Neurol. 2020 Sep;28:29-37. doi: 10.1016/j.ejpn.2020.06.020. Epub 2020 Jul 28. PMID: 32807681.

4. FitzGerald PM, Jankovic J, Percy AK. Rett syndrome and associated movement disorders. Mov Disord. 1990;5(3):195-202. doi: 10.1002/mds.870050303. PMID: 2388636.

Fonte de Fomento (se houver)

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Transtornos do movimento