Opsoclonus-Myoclonus-Ataxia Syndrome (OMAS) Associated with SARS-CoV-2 Infection: Post-Infectious Neurological Complication with Benign Prognosis

Abstract

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) is the cause of the COVID-19 pandemic [ 5 ]. SARS-Cov-2 demonstrates partial resemblance to SARS-CoV and MERS-CoV in phylogenetic analysis, clinical manifestations, and pathological findings [ 6 , 7]. Reports emerging from China have described ataxia as a neurological symptom of the SARS-CoV-2 infection [ 5 ]. Opsoclonus consists of back-to-back multidirectional conjugate saccades without an inter-saccadic interval [ 8 ]. Myoclonus is defined as a sudden, brief, “shock-like”, nonepileptic involuntary movement [ 9 ], which has been described as a symptom of SARS-CoV-2 infection [ 10 ]. Opsoclonus-Myoclonus-Ataxia syndrome (OMAS) associated COVID-19 infection has been reported recently [ 11 12 ].

Post-COVID Opsoclonus Myoclonus Syndrome: A Case Report From Pakistan

“…Our case provides further evidence that COVID-19 can trigger OMS irrespective of the severity of respiratory symptoms in such patients ( 2 , 3 , 12 – 14 ). Hence, further research is needed to dissect the underlying pathophysiological mechanisms associated with COVID-19-induced neurological disorders including OMS.…”

“…The emergence of neurological disorders, particularly OMS following COVID-19 infection, has been recently reported in several studies ( 2 , 3 , 12 – 14 ). Interestingly, the majority of these COVID patients developing OMS were affected by mild-to-moderate respiratory symptoms as observed in our case ( 2 ).…”

Temporal Changes in Brain Perfusion in a Patient with Myoclonus and Ataxia Syndrome Associated with COVID-19

“…This is the first report of COVID-19-related myoclonus and ataxia in Japan and also the first to illustrate brain perfusion findings on SPECT in a patient with COVID-19- As in our case, no previous case reports of myoclonus and ataxia with or without opsoclonus have shown CSF pleocytosis, and PCR tests for SARS-CoV-2 in the CSF were negative in all cases tested (2,3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Furthermore, brain MRI in previous case reports showed unremarkable results in almost all patients (2,3,5,(7)(8)(9)(11)(12)(13)(14)(15)(16)(17)(18)(19), except for one case that showed diffuse pachymeningeal enhancement (10). All previous cases were assumed to be associated with postinfectious or parainfectious complications of COVID-19 (2,3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)…”

“…Furthermore, brain MRI in previous case reports showed unremarkable results in almost all patients (2,3,5,(7)(8)(9)(11)(12)(13)(14)(15)(16)(17)(18)(19), except for one case that showed diffuse pachymeningeal enhancement (10). All previous cases were assumed to be associated with postinfectious or parainfectious complications of COVID-19 (2,3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

COVID-19 and Vaccination in the Setting of Neurologic Disease

“…20 It is also possible that the virus triggers underlying neurologic disease through immunomodulation as there have been case reports of acute inflammatory demyelinating polyneuropathy (AIDP), acute myoclonus, acute cerebellitis with ataxia, encephalitis, and status epilepticus occurring as para-or post-infectious phenomena. 9,[21][22][23][24] Long-term sequelae have been reported following previous viral epidemics; however, clear evidence linking specific complications to prior viral infection remains somewhat controversial and do not appear related to a single mechanism of action. The 1918 H1N1 pandemic's association with post encephalitic parkinsonism (PEP) and Zika virus induced congenital Zika syndrome are prominent examples.…”