Opsoclonus

Involuntary, chaotic bursts of multidirectional, high-amplitude saccadic movements. There is no intersaccadic interval, are not rhythmical and have long silent periods followed by bursts of eye movement.

“Ocular flutter” = Purely horizontal opsoclonus

• Transient phenomenon in neonates: “Neonatal Opsoclonus” or “Benign Neonatal Ocular Flutter”
  • Video Example
• Paraneoplastic
  • Neurocrest Tumors
    • Neuroblastoma
  • Other tumors with paraneoplastic effects in Adults
    • non-Hodgkins lymphoma, renal adenocarcinoma, oat cell tumor of lung
• Brain Disease/Infection
  • Kinsbourne myoclonic encephalopathy (“benign encephalitis”)
    • Prodrome of malaise and fever are followed by vertigo, trucal ataxia, cerebellar signs, shivering movements of the head and body and forceful myoclonic jerks of head and body along with opsoclonus
    • Treated with corticosteroids, IVIG, ACTH azathioprine, monoclonal antibodies to B-lymphocytes (rituximab), clonazepam and propranolol.
  • Meningitis
  • Encephalitis
  • Hydrocephalus
  • Intracranial tumors
  • Neuroborreliosis
  • Multiple Sclerosis
  • Thalamic Hemorrhage
• Toxins
  • Chlordecone, Organophosphates, strychnine, thallium, toluene
• Drugs
  • Amitriptyline, Cocaine, Lithium, phenytoin with diazepam, phenelzine with imipramine
• Systemic Conditions/Disease
  • Pregnancy
  • Ciliac disease
  • Sarcoid
  • Hyperosmolar coma
  • Carbohydrate-deficient glycoprotein syndrome
  • Post streptococcal dyskineisa
  • Post allogenic hematopoietic stem cell transplant
• Systemic Infections
  • HIV
  • Viral Hepatitis
  • West Nile Virus
  • Lyme Disease

1. “Opsoclonus and Ocular Flutter” Chapter 8 Nystagmus in Children, section: Saccadic Oscillations that Simulate Nystagmus, Pediatric Neuro-Ophthalmology. 2nd Edition, Michael C. Brodsky. Springer 2nd Ed. p 421-423.
2. An Upate on opsoclonus. Agnus Wong, Curr Opin Neurol 2007;20:25-31.