Download - Dancing eyes-dancing feet’ Disease
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Dancing eyes-dancing feetSyndrome
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Presenting Complaint 32y.o male presented with subacute onset of
nystagmus, myoclonic jerks and ataxia.
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History Presenting Complaint Had labyrinthitis for one week nausea and
vomiting, subjective vertigo, dizziness
Lying on his right side alleviates symtoms
Prescribed Prochlorperazine which relieves hissymtoms
Involuntary muscle and eye movementspronounced insomniac
Loss of appetite and weight of 1 stone over 1week
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Past Medical HistoryAsthma Hayfever
Bronchitis
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Drug History No allergies Prochlorperazine(10mg)-TD
Never take recreational drugs
Not taking vaccine recently
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General Inspection and Examination Resting tremorAfrebile(36.4C)
Bradycardia (32 beats/minute)
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Neurological examination Cranial nerve examination- Square-wave
nystagmus (Video 1), reduced pupil size,diplopia, photophobia
Limbs examination- Generalisedmyoclonus(Video 2), mild spasticity, areflexia,reduced plantar response
Wide-based ataxic gait,
Positive Romberg test
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Summary 32 y.o male who is on Prochloperazine, presented
with 3-day history of worsening nystagmus andmyoclonic jerks, preceded by labyrinthithis
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Differential diagnoses Cerebellar Disorder Post-infectious Syndrome
Neoplastic Syndrome
Side-effect of Prochlorperazine
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Investigations FBC-normal U&E-normal
LFTs-normal
CSF- IgG Oligoclonal bands, Lymphocyticpleocytosis (99%)
Viral Serology(blood and CSF)-negative
Chest X-ray -No abnormality
MRI-No abnormality
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Treatment Symtomatic- Clonazepam(0.5mg TD), Sodium
Valproate(100mg BD), IV Cyclizine (50mg TD)
Improved significantly and discharged after 4days
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Literature reviewTreatment Number of cases
IV Immunoglobulin 6
Anticonvulsant(Clonazepam,Clorazepate)
5
Corticosteroid(Prednisolone) 3
Immunosuppressant(Azathioprine) 1
Conservative 1Table 1: Treatment of idiopathic Dancing eyes, dancing feet Syndrome
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Dancing eyes, dancing feet
SyndromeA.k.a. Kinsbourne syndrome oropsoclonus-
myoclonus syndrome Causes
Idiopathic Post-viral infection-Epstein-Barr, Varicella
Zoster, enterovirus Neoplastic-breast cancer, sarcoidosis, small-cell
lung cancer
Vaccine (Rubella and Human Papillomavirus), Drug( amitriptyline, haloperidol, lithium,
phenytoin, diazepam, and cocaine)
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Take-home message History-taking-ask about recent infection, drug
and vaccine intake
Investigation- Chest X-ray and MRI to excludeany underlying malignancy
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References 1. Morris E. Opsoclonus-myoclonus. MedLink Neurology. 2006.
2. Imtiaz K, Vora J. Dancing eyes-dancing feet. Lancet. 1999;354(9176):390.
3. Candler P, Dale R, Griffin S, Church A, Wait R, Chapman M, et al. Post-streptococcal opsoclonus-myoclonus syndrome associatedwith anti-neuroleukin antibodies. Journal of Neurology, Neurosurgery & Psychiatry. 2006;77(4):507.
4. Veneselli E, Conte M, Biancheri R, Acquaviva A, De Bernardi B. Effect of steroid and high-dose immunoglobulin therapy onopsoclonus-myoclonus syndrome occurring in neuroblastoma. Medical and pediatric oncology. 1998;30(1):15-7.
5. Celebisoy N, Akyrekli , Colakoglu Z, Toygar A. Opsoclonus in adults: a report of four cases. Neuro-Ophthalmology.1997;17(1):45-8.
6. Gwinn K, Caviness J. Electrophysiological observations in idiopathic opsoclonusmyoclonus syndrome. Movement Disorders.1997;12(3):438-42.
7. Barto A, Pitha J. Opsoclonusmyoclonusdysequilibrium syndrome: cytological and immunological dynamics in the serial
cerebrospinal fluid in two patients. Journal of neurology. 2003;250(12):1420-5. 8. Glatz K, Meinck H, Wildemann B. Parainfectious opsoclonus-myoclonus syndrome: high dose intravenous immunoglobulins are
effective. Journal of Neurology, Neurosurgery & Psychiatry. 2003;74(2):279.
9. Bataller L, Graus F, Saiz A, Vilchez J. Clinical outcome in adult onset idiopathic or paraneoplastic opsoclonus-myoclonus. Brain.2001;124(2):437.
10. Markakis I, Alexiou E, Xifaras M, Gekas G, Rombos A. Opsoclonus-myoclonus-ataxia syndrome with autoantibodies to glutamicacid decarboxylase. Clinical neurology and neurosurgery. 2008;110(6):619-21.
11. Pittock S, Lucchinetti C, Lennon V. Anti neuronal nuclear autoantibody type 2: Paraneoplastic accompaniments. Annals ofneurology. 2003;53(5):580-7.
12. Luque F, Furneaux H, Ferziger R, Rosenblum M, Wray S, Schold Jr S, et al. Anti Ri: An antibody associated with paraneoplasticopsoclonus and breast cancer. Annals of neurology. 1991;29(3):241-51.
13. Lapenna F, Lochi L, de Mari M, Iliceto G, Lamberti P. Post-vaccinic opsoclonus-myoclonus syndrome: a case report. Parkinsonism& Related Disorders. 2000;6(4):241-2.
14. McCarthy J, Filiano J. Opsoclonus Myoclonus after human papilloma virus vaccine in a pediatric patient. Parkinsonism & RelatedDisorders. 2009;15(10):792.
15. Wong A, Musallam S, Tomlinson R, Shannon P, Sharpe J. Opsoclonus in three dimensions: oculographic, neuropathologic andmodelling correlates. Journal of the neurological sciences. 2001;189(1-2):71-81.
16. Helmchen C, Rambold H, Sprenger A, Erdmann C, Binkofski F. Cerebellar activation in opsoclonus: an fMRI study. Neurology.2003;61(3):412.
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Acknowledgment