title: Immunologic and clinical responses to rituximab in a child with opsoclonus-myoclonus syndrome.
abstract: Opsoclonus-myoclonus syndrome (OMS) is an autoimmune disorder with serious neurodevelopmental morbidity and limited treatment options. We treated a toddler with moderately severe OMS with rituximab, a monoclonal anti-B cell antibody. The patient's clinical response was documented on videotape and scored with the OMS Evaluation Scale. Cerebrospinal fluid lymphocyte subsets were evaluated by flow-cytometric immunophenotyping, with a comprehensive panel of monoclonal antibodies. Eradication of cerebrospinal fluid B cells, which previously were expanded, was associated with dramatic clinical improvement. There also were secondary changes in other lymphocyte subsets that might be relevant to the clinical response and lack of serious infections. In addition to clarifying the immune response to B-cell depletion, these data reveal a promising new therapy for OMS that warrants a phase I clinical trial.
authors.affiliation: Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9643, USA. pranzatelli@siumed.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pranzatelli
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Tate
authors.forename: Anna L
authors.initials: AL
authors.lastname: Travelstead
authors.forename: Darryl
authors.initials: D
authors.lastname: Longee
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007694:Killer Cells, Natural; D018655:Lymphocyte Count; D020361:Paraneoplastic Syndromes, Nervous System / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab; D013601:T-Lymphocytes
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab