Miller-Fisher syndrome

Alternate names

Cranial variant of Guillain-Barré syndrome; Cranial variant of GBS

Definition

Miller Fisher syndrome is a rare, acquired nerve disease that is considered to be a variant of Guillain-Barré syndrome. It is characterized by abnormal muscle coordination, paralysis of the eye muscles, and absence of the tendon reflexes.

Epidemiology

• The worldwide incidence of GBS is approximately 1 to 2 in 100,000, with MFS variant representing a tiny subset of the cases (1 to 2 in 1,000,000).
• It affects more men than women with an approximate gender ratio of 2:1 and a mean age of 43.6 years at the onset of disease.[1].

Cause

• MFS and GBS are thought to result from an aberrant acute autoimmune response to a preceding infection (e.g., Campylobacter jejuni, Cytomegalovirus, Epstein-Barr virus, or human immunodeficiency virus (HIV).
• A cross-reaction between peripheral nerve antigens and microbial/viral components through molecular mimicry is thought to drive the inflammatory process of this illness.[2].

Onset

Symptoms often start several days after a viral illness.

Signs and symptoms

• The main features are lack of muscle coordination (ataxia), eye muscle weakness resulting in the inability to move the eyes in several directions (ophthalmoplegia), and the absence of tendon reflexes.
• Other symptoms include generalized muscle weakness and respiratory failure.

Diagnosis

• In most people with Miller Fisher syndrome an antibody (anti-GQ1b) is identified.
• The presence of these autoantibodies helps confirm the diagnosis of the syndrome.

Treatment

Treatment for Miller Fisher syndrome is identical to treatment for Guillain-Barré syndrome: intravenous immunoglobulin (IVIg) or plasmapheresis (a procedure in which antibodies are removed from the blood) and supportive care.

Prognosis

• The prognosis for most individuals with Miller Fisher syndrome is good.
• In most cases, recovery begins within 2 to 4 weeks of the onset of symptoms, and may be almost complete within 6 months.
• Some individuals are left with residual deficits.
• Relapses may occur rarely (in less than 3 percent of cases).

NIH genetic and rare disease info

• NIH info on Miller-Fisher syndrome

Miller-Fisher syndrome is a rare disease.

Miller-Fisher syndrome Resources
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