Miller Fisher Syndrome

Miller Fisher Syndrome

Miller Fisher syndrome is another rare variant of Guillain-Barré syndrome. One of the differences from Guillain-Barré syndrome is that Miller Fisher syndrome may be characterized by descending paralysis. When Guillain-Barré syndrome starts from the legs and move up, Miller Fisher syndrome begins with symptoms related to eye muscles, these symptoms may move down. Miller-Fisher syndrome is characterized by paralysis of the eye muscles (ophthalmoplagia), abnormal muscle coordination (ataxia), and absence of the tendon reflexes (areflexia).

The cause of this syndrome is also not clear as is the case with Guillain-Barré syndrome, though like in Guillain-Barré syndrome infections are suspected to be an underlying factor. Antibodies to the GQ1b (ganglioside) epitope is often tested, as serum from many patients with Miller Fisher syndrome contains antibodies to this neuronal ganglioside (a gangliside a ceramide oligosaccharide, which means that it is a complex molecule with lipids and sugars). Third, fourth and sixth cranial nerves contain good amounts of this ganglioside (Plomp JJ et al, Ann Neurol, 1999; 45:189). However, it is not clear whether these antibodies are the cause of the disease or its symptoms. Treatment methods are similar to that proposed for Guillain barre syndrome; intravenous immunoglobulin (IVIG) and plasmapheresis are used. It is reported that recurrence of Miller-Fisher syndrome may occur (Kuitwaard et al, J Neurol Neurosurg Psychiatry. 2009;80:3). An expert neurologist may be required to diagnose Miller Fisher syndrome.

Additional Reading:
JB Winer. Bickerstaff's encephalitis and the Miller Fisher syndrome. J Neurol Neurosurg Psychiatry. 2001 October; 71(4): 433–435

Plomp JJ, Molenaar PC, O'Hanlon GM, Jacobs BC, Veitch J, Daha MR, van Doorn PA, van der Meché FG, Vincent A, Morgan BP, Willison HJ. Miller Fisher anti-GQ1b antibodies: alpha-latrotoxin-like effects on motor end plates. Ann Neurol. 1999 Feb;45(2):189–199.

Schabet M. Miller Fisher syndrome. Pract Neurol. 2009 Oct;9(5):289-91.

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