OMS Manual/Chapter 4

CHAPTER 4 - ONSET OF OMS

Description
This is generally the order in which the most prevalent symptoms of OMS can occur at the onset of the disease. As with many aspects of OMS, there are no steadfast rules or absolute consistencies. Some children will experience all of these symptoms in the order described below, some will experience only some of the symptoms, and in some, the order of appearance of symptoms will differ. The time frame in which the symptoms appear can also vary. In some, progression of disease in it’s acute phase can occur over a few days, in others it may be weeks or months. For a diagnosis of OMS to be made, technically only opsoclonus and myoclonus need to be present and all other more common causes of the two symptoms ruled out.

First Symptoms
Many parents of children who have been diagnosed with OMS, report that in the six to four weeks prior to any visable physical symptoms of disease, there are notable changes in the behavior of the child. A child who was once easy going and happy, will suddenly become oppositional or begin having exaggerated temper tantrums. Parents often think these behavioral changes are part of a developmental phase. The child may also wake more during the night during this time. There may also be some instances of problems with gross motor skills, tripping or falling more than usual, but nothing that would necessarily cause any concern, and would generally go unnoticed.

Next Symptoms
The child will suddenly be unable to walk properly or at all. If the child is still walking, he or she may appear to be walking like a drunkard. The child may complain of dizziness and refuse or not be able to stand unassisted. He or she may refuse to go down flights of stairs. A child that was once independent will become incredibly clingy. At this time, the child may also begin to struggle with fine motor skills especially with feeding. Behavior problems, separation anxiety, crying, and rage attacks may become more prevalent.

Further Progression of Symptoms
The child will lose the ability to sit unassisted (without support). They may not be able to hold their head up. The body will appear to be limp and floppy. Rage attacks persist along with sleep disturbance, and these states may be interrupted by periods of extreme lethargy and malaise. Myoclonus (full-body tremor or gross jerking) may begin, and may occur most when movement is attempted, be worse if the child is agitated or stimulated, but can also be present when the child is in a resting state.

Loss of all Function
Speech will become slurred or sound jerky, and eventually will be lost all together. Opsoclonus will begin, and may be nearly constant. The child may lose the ability to eat due to issues with swallowing or vomiting and may need to be fed temporarily with a g tube. The child may be in a constant state of distress; screaming, biting, back-arching, flailing. He or she may only be able to sleep for minutes at a time. Attempts to sedate or calm with drugs commonly used for sedation or seizures will most likely not work or potentially make the state of distress even worse.