Letter of Medical Necessity for
Spinal Tap

Opsoclonus-myoclonus syndrome (OMS) is an autoimmune disorder, which is caused by neuroblastoma or certain viral infections. Most children have chronic neurological symptoms such as mood disorder, sleep disturbance, speech articulation problems, learning and cognitive impairment. They relapse with tapering of steroids or with viral infections.

We now know that the cerebrospinal fluid (CSF) of these children often shows inflammation, which is indicative of brain inflammation. The only way to reduce the morbidity of OMS and improve prognosis is to eliminate this inflammation. Routine lab testing of spinal fluid usually misses it because the total number of cells may be normal, but the proportion of inflammatory cells is increased.

Ours is the only center with experience in interpreting results in children that offers sophisticated immunophenotyping testing on spinal fluid. The testing must be done on freshly acquired CSF leukocytes, so it cannot be shipped, even by courier. We use this information to select the best treatment. There is no other way to get this information than to do a spinal tap.