TY - JOUR
T1 - Ocular Neuromyotonia in Children and Adolescents Following Radiation Treatment of Pediatric Brain Tumors
AU - Richardson, Cody
AU - Smith, Casey
AU - Merchant, Thomas
AU - Khan, Raja
AU - Hoehn, Mary Ellen
N1 - Funding Information:
From the Departments of Surgery (CR, MEH), Radiation Oncology (TM), and Neurology (RK), St. Jude Children’s Research Hospital, Memphis, Tennessee; Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee (CR, CS, MEH); and Krieger Children’s Eye Center at The Wilmer Institute, Johns Hopkins Hospital, Baltimore, Maryland (CR). Submitted: July 1, 2021; Accepted: November 1, 2021; Posted online; February 23, 2022 Supported by an unrestricted grant to the Department of Ophthalmology at the University of Tennessee from Research to Prevent Blindness, Inc, New York, New York, Grant P30 CA 21765 from the National Institutes of Health, and the American Lebanese Syrian Associated Charities. Disclosure: The authors have no financial or proprietary interest in the materials presented herein. Correspondence: Cody Richardson, MD, Krieger Children’s Eye Center at The Wilmer Institute, 600 N. Wolfe St., Wilmer 233, Baltimore, MD 21287.
Publisher Copyright:
© 2022 Slack Incorporated. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Purpose: To report five cases of ocular neuromyotonia in children and adolescents following radiation therapy for a variety of pediatric brain tumors. Notably, three cases occurred in children younger than 11 years. Methods: Case series of five patients with ocular neuromyotonia following proton beam therapy or conventional radiation. Results: Five cases of ocular neuromyotonia were identified following radiation treatment of various pediatric brain tumors. Onset ranged from 5 to 142 months after radiation treatment. The abducens nerve/lateral rectus muscle was affected in three patients, and the trochlear nerve/superior oblique muscle was affected in two patients. Ages at symptom presentation were 4 years (intermittent head tilt), 9 years (intermittent blurry vision and head tilt), 10 years (intermittent blurry vision progressing to intermittent diplopia), 15 years (intermittent diplopia), and 17 years (intermittent diplopia). One patient improved with gabapentin. Two patients experienced spontaneous resolution. One patient died due to metastatic disease, and one patient has planned follow-up. Conclusions: Ocular neuromyotonia occurs most commonly following radiation to the brain and skull base. Clinicians need to be aware that ocular neuromyotonia presents differently in children (who may not report diplopia) than in adults or adolescents (who typically report diplopia). Two children in this series never reported diplopia, only intermittent head tilt and blurry vision. Ocular neuromyotonia requires a high index of suspicion to diagnose, especially in children. Membrane stabilizers can be used effectively, but observation may be a valid option in children because spontaneous resolution was seen.
AB - Purpose: To report five cases of ocular neuromyotonia in children and adolescents following radiation therapy for a variety of pediatric brain tumors. Notably, three cases occurred in children younger than 11 years. Methods: Case series of five patients with ocular neuromyotonia following proton beam therapy or conventional radiation. Results: Five cases of ocular neuromyotonia were identified following radiation treatment of various pediatric brain tumors. Onset ranged from 5 to 142 months after radiation treatment. The abducens nerve/lateral rectus muscle was affected in three patients, and the trochlear nerve/superior oblique muscle was affected in two patients. Ages at symptom presentation were 4 years (intermittent head tilt), 9 years (intermittent blurry vision and head tilt), 10 years (intermittent blurry vision progressing to intermittent diplopia), 15 years (intermittent diplopia), and 17 years (intermittent diplopia). One patient improved with gabapentin. Two patients experienced spontaneous resolution. One patient died due to metastatic disease, and one patient has planned follow-up. Conclusions: Ocular neuromyotonia occurs most commonly following radiation to the brain and skull base. Clinicians need to be aware that ocular neuromyotonia presents differently in children (who may not report diplopia) than in adults or adolescents (who typically report diplopia). Two children in this series never reported diplopia, only intermittent head tilt and blurry vision. Ocular neuromyotonia requires a high index of suspicion to diagnose, especially in children. Membrane stabilizers can be used effectively, but observation may be a valid option in children because spontaneous resolution was seen.
UR - http://www.scopus.com/inward/record.url?scp=85139374108&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85139374108&partnerID=8YFLogxK
U2 - 10.3928/01913913-20220124-01
DO - 10.3928/01913913-20220124-01
M3 - Article
C2 - 35192380
AN - SCOPUS:85139374108
SN - 0191-3913
VL - 59
SP - 338
EP - 343
JO - Journal of pediatric ophthalmology and strabismus
JF - Journal of pediatric ophthalmology and strabismus
IS - 5
ER -