Objective: To present a rare neurological syndrome as a potential parainfectious complication of SARS-CoV-2 infection.

Background: Օpsoclonus myoclonus syndrome (OMS) is rare complication of the oncological or infection disease, sometimes it can be manifested without known ethiology. Some publications suggests that OMS can be also parainfectious complication of the  COVID-19. Our three cases diagnosed in 2020 and monitored for nearly two years confirm the potential role of COVID-19 in the pathogenesis of this rare syndrome.

Method: We observed three patients who were admitted to the COVID clinic with a positive PCR test and severe clinical course of coronavirus disease and developed opsoclonus myoclonus ataxia syndrome on average 7-12 days after the onset of illness. Patients were monitored for two years after treatment and discharge, periodically repeating immunological, paraneoplastic tests.

Results: We presented three cases (82-year-old woman, 38- and 56-year-old man) in which SARS-CoV-2 infection was associated with severe opsoclonus-myoclonus syndrome. In the clinical picture, in addition to cortical myoclonus, limbs and trunk pronounced ataxia and opsoclonus, tremor of the tongue, palatal myoclonus and a pronounced postural kinetic tremor of the upper extremities were observed(the tremor responded only to the use of propranolol). Brain MRI, cerebrospinal fluid examination, antineuronal, paraneoplastic antibodies, tumor markers, and a comprehensive panel of 16 respiratory infections, hepatitis, and venereal diseases were all negative in all three patients. The above studies were repeated after 6 and 18 months and again were negative. Whole-body MRI oncological screening was negative. All three patients were treated with methylprednisolone 1g-3 days, valproic acid 1500 mg/day, clonazepam 2-4 mg/day, levetiracetam 1500-2000 mg/day, and symptoms completely resolved after a median of 12 weeks.

Conclusion: We hypothesize that opsoclonus myoclonus ataxia syndrome may be a potential parainfectious complication of COVID-19, with severe symptomatology and a potentially reversible course despite the need for multiple medications. Larger studies are needed to confirm the connection and clarify the pathogenesis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/covid-19-associated-opsoclonus-myoclonus-ataxia-syndrome/