Disclosures: Adeel Malik, DO: Nothing to disclose

Case Description: Patient presented with 3 days of unsteady gait, uncontrolled eye fluttering and involuntary muscle twitches and jerky movements. Patient was also noted to be intermittently irritable with associated sleep deprivation. Patient underwent extensive lab work. Patient found to be positive for RSV. Patient underwent lumbar puncture which was positive for oligoclonal bands. Neoplastic workup was negative. MRI of the brain revealed diffuse periventricular white matter disease. A diagnosis of OMAS was suspected given unique clinical findings with possible viral source. Patient completed 5 days of IVIG and methylprednisolone. Patient was transitioned to long term prednisone and subsequently admitted to acute inpatient rehabilitation.

Setting: Tertiary Care Center

Patient: 46-year-old male with past medical history of hypertension.

Assessment/Results: While in acute rehabilitation, the patient made significant improvement with symptoms and function. In total, over a 14-day length of stay, we saw a total FIM change of 25 from 82 to 107. Of note, FIM scores of both walking and navigating stairs improved from 1 to 5 from admission to discharge, with walking improving from 15 feet to 150 feet. The FIM scores of bed, chair, wheelchair transfers as well as toileting improved from 1 to 4. Patient also noted improvement of eye fluttering, myoclonic jerks, irritability and balance.

Discussion: OMAS is a rare inflammatory neurological disorder. Diagnosis is clinical with demonstration of at least 3 of the following: opsoclonus, diffuse or focal body myoclonus, truncal titubation with or without ataxia and other cerebellar signs, and behavioral change. OMAS typically occurs in association with tumors or following a viral or bacterial infection. Therapy may include: treating the source, corticosteroids, IVIG, and gait, balance and transfer training.

Conclusion: Due to early aggressive multidisciplinary rehabilitation in combination with IVIG and corticosteroids, our patient was able to see vast symptomatic and behavioral improvement as well as good functional outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-rehabilitation-in-opsoclonus-myoclonus-ataxia-syndrome-a-case-report/