(Kiosk 3) Challenges of Acute Inpatient Rehabilitation in a Patient with Opsoclonus-myoclonus-ataxia Syndrome

Case Diagnosis: Opsoclonus-Myoclonus-Ataxia Syndrome (OMAS)

Case Description or Program Description: An 18 year old female with recent gastroenteritis who presented with lower extremity weakness and gait instability. Through the course of admission, she developed significant opsoclonus, myoclonus and behavioral changes, suggestive of OMAS. Extensive work up for underlying etiology of the syndrome were inconclusive; the differential diagnosis upon discharge was OMAS- post infectious vs parancoplastic vs autoimmune NOS. The patient received Solu-Medrol, IVIG, and Rituximab with minimal improvement.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: Once stable, she completed an acute inpatient rehabilitation program. On admission, she required total to maximum assistance for bed mobility, transfers, and ADLs, and she was not ambulatory. Her course was challenging due to the extent of her myoclonus, ataxia, cognitive deficits, mood disorder, and visual impairments. She responded to clonazepam and valproic acid for her movement disorders.
Despite all the limitations, she demonstrated steady functional progress, achieving ADLs with set up assistance, ambulation and stairs with minimal assistance and weighted equipment. Her family was trained to take care of her independently and allow for a safe discharge home. She was able to reintegrate into the community and returned to school.

Discussion (relevance): OMAS is a very rare disorder, oftentimes without a clear etiology, resulting in extensive work up and a possible delay in treatment. While pharmacologic and nonpharmacologic interventions can be utilized to minimize symptoms, an acute inpatient rehabilitation program is an integral part of the care to maximize functional abilities. The interdisciplinary approach has the knowledge, skill, and resources to properly manage the complexity of these cases.

Conclusions: As evidenced by our patient, OMAS is a rare disorder that can result in significant disability and reduction in quality of life. There is scarce research regarding the role of rehabilitation, but this case illustrates the impact of rehabilitation in optimizing independence.