• Reduction in inflammatory cytokines [ Time Frame: 6 and12 months ] [ Designated as safety issue: No ]
  

• Correlation of cytokine concentration and clinical severity score. [ Time Frame: 6 and 12 months ] [ Designated as safety issue: No ]
  

In this translational research, immunological mechanisms that underlie the assault of the immune system on the brain in paraneoplastic opsoclonus-myoclonus syndrome (OMS) are under evaluation. To test our principal hypothesis that there is an imbalance of pro-inflammatory (Th1) and anti-inflammatory (Th2) cytokines in OMS, a comprehensive cytokine panel will be measured by enzyme-linked immunoadsorbent assay (ELISA) and multiplexed fluorescent bead-based immunoassay detection (LUMINEX 100 Lab MAP system)in blood and CSF of 400 children. To test the second hypothesis that cytokines could serve as biomarkers of disease activity in OMS, cytokine concentrations will be correlated with clinical variables, such as disease severity, OMS duration, prior relapses, and remissions, as well as immunological variables, such as lymphocyte subset analysis. The cytokine 'biomarker profile' could aid decision making for early intervention by identifying children at high risk for relapse and poor outcome and allow targeting of the most implicated inflammatory cytokines by cytokine therapies. To test our third hypothesis that lack of response to immunotherapy is due in part to failure to increase the expression of anti-inflammatory Th2 cytokines, we will determine the longitudinal effects of standard immunotherapy, such as steroids, ACTH, IVIg, and chemotherapy, given in the course of clinical care on the cytokine profile. This research could lead to the application of commercially-available cytokines and cytokine blockers or to the development of new ones for OMS.