of 19 months (6 to 36 months), a diagnosis can be slow. Some cases have been diagnosed as having been caused by a virus. After a diagnosis of OMS is made, an associated neuroblastoma is discovered in half of cases, with median delay of 3 months. The interictal EEG pattern is usually normal. Treatment There is no known definitive cure for OMS. However, several drugs have proven to be effective in their treatment. Some of medication used to treat the symptoms are: ACTH has shown improvements in symptoms but can result in an incomplete recovery with residual deficits. Corticosteroids (such as prednisone or methylprednisolone) used at high dosages (500 mg - 2 g per day intravenously for a course of 3 to 5 days) can accelerate regression of symptoms. Subsequent very gradual tapering with pills generally follows. Most patients require high doses for months to years before tapering. Intravenous Immunoglobulins (IVIg) are often used with varying results. Several other immunosuppressive drugs, such as cyclophosphamide and azathioprine, may be helpful in some cases. Chemotherapy for neuroblastoma may be effective, although data is contradictory and unconvincing at this point in time. Rituximab has been used with encouraging results. Other medications are used to treat symptoms without influencing the nature of the disease (symptomatic treatment): Trazodone can be useful against irritability and sleep problems Additional treatment options include plasmapheresis for severe, steroid-unresponsive relapses. The National Organization for Rare Disorders (NORD) recommends FLAIR therapy consisting of a three-agent protocol involving front-loaded high-dose ACTH, IVIg, and rituximab that was developed by the National Pediatric Myoclonus Center, and has the best-documented outcomes. Almost all patients (80-90%) show improvement with this treatment and the relapse rate appears to be about 20%. A more detailed summary of current treatment options can be found at Treatment Options The following medications should probably be avoided: Midazolam - Can cause irritability. Melatonin - Is known to stimulate the immune system. Also, see for more details Prognosis Currently, there are no clinically established laboratory investigations available to predict prognosis or therapeutic response. Tumors in children who develop OMS tend to be more mature, showing favorable histology and absence of n-myc oncogene amplification than similar tumors in children without symptoms of OMS. Involvement of local lymph nodes is common, but these children rarely have distant metastases and their prognosis, in terms of direct morbidity and mortality effects from the tumor, is excellent. The