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Miller Fisher Syndrome – Four Case Reports and Review of Current Concept


Authors: Z. Ambler;  J. Valeš
Authors‘ workplace: Neurologická klinika LF UK a FN Plzeň
Published in: Cesk Slov Neurol N 2011; 74/107(6): 689-694
Category: Case Report

Overview

Miller Fisher syndrome (MFS) is a rare disorder considered to be a clinical variant of Guillain-Barré syndrome (GBS), an acute post-infection inflammatory disorder of the peripheral nerves. The classic triad of ophthalmoplegia, ataxia and areflexia is often clinically recognizable, but sometimes other cranial nerves may be affected, especially the caudal (bulbar syndrome) or facial nerves. MFS is generally regarded as a self-limiting, benign condition with a good prognosis and recovery with no residual deficits. Overlap syndromes sharing features of GBS with weakness of limb and even respiratory muscles may occur rarely. The anti-ganglioside antibodies anti-GQ1b IgG are found in more than 90% of MFS patients and are an excellent diagnostic marker. In this review, we report four cases of MFS confirmed by the presence of anti-GQ1b antibodies and summarize characteristics of its neurological symptoms and signs, the current state of knowledge about pathogenesis, and findings relevant to correct diagnosis. Related disorders, which may be accompanied by positive anti-GQ1b antibodies, are also mentioned.

Key words:
Miller Fisher syndrome – antiganglioside antibodies – molecular mimicry – anti-GQ1b syndrome


Sources

1. Fisher M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med 1956; 255(2): 57–65.

2. Lo YL. Clinical and immunological spectrum of the Miller Fisher syndrome. Muscle Nerve 2007; 36(5): 615–627.

3. Lyu RK, Tang LM, Cheng SY, Hsu WC, Chen ST. Guillain-Barré syndrome in Taiwan: a clinical study of 167 patients. J Neurol Neurosurg Psychiatry 1997; 63(4): 494–500.

4. Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T. Clinical features and prognosis of Miller Fisher. Neurology 2001; 56(8): 1104–1106.

5. Yuki N. Infectious origins of, and molecular mimicry in, Guillain-Barré and Fisher syndromes. Lancet Infect Dis 2001; 1(1): 29–37.

6. Willison HJ, Yuki N. Peripheral neuropathies and anti-glycolipid antibodies. Brain 2002; 125(12): 2591–2625.

7. Overell JR, Willison HJ. Recent developments in Miller Fisher syndrome and related disorders. Cur Opin Neurol 2005; 18)5): 562–566.

8. Ang CW, Jacobs BC, Laman JD. The Guillain-Barré syndrome: a true case of molecular mimicry. Trends Immunol 2004; 25(2): 61–66.

9. Willison HJ. Ganglioside complexes as targets for antibodies in Miller Fisher syndrome. J Neurol Neurosurg Psychiatry 2006; 77(9): 1002–1003.

10. Yuki N. Ganglioside mimicry and peripheral nerve disease. Muscle Nerve 2007; 35(6): 691–711.

11. Kanzaki M, Kaida K, Ueda M, Morita D, Hirakawa M, Motoyoshi K et al. Ganglioside complexes containing GQ1b as targets in Miller Fisher and Guillain--Barré syndromes. J Neurol Neurosurg Psychiatry 2008; 79(10): 1148–1152.

12. Kaida K, Ariga T, Yu RK. Antiganglioside antibodies and their pathophysiological effects on Guillain--Barré syndrome and related disorders – a review. Glycobiology 2009; 19(7): 676–692.

13. Kaida K, Kusunoki S. Antibodies to gangliosides and ganglioside complexes in Guillain-Barré syndrome and Fisher syndrome: mini-review. J Neuroimmunol 2010; 223(1–2): 5–12.

14. Kivity S, Agmon-Levin N, Blank M, Shoenfeld Y. Infections and autoimmunity – friends or foes? Trends Immunol 2009; 30(8): 409–414.

15. Yuki N. Campylobacter sialyltransferase gene polymorphism directs clinical features of Guillain--Barré syndrome. J Neurochem 2007; 103 (Suppl 1): 150–158.

16. Jacobs BC, Bullens RW, O’Hanlon GM, Ang CW, Willison HJ, Plomp JJ. Detection and prevalence of α-latrotoxin-like effects of serum from patients with Guillain-Barré syndrome. Muscle Nerve 2002; 25(4): 549–558.

17. Buchwald B, Bufler J, Carpo M, Heidenreich F, Pitz R, Dudel J et al. Combined pre- and postsynaptic action of IgG antibodies in Miller Fisher syndrome. Neurology 2001; 56(1): 67–74.

18. Kuwabara S, Misawa S, Takahashi H, Sawai S, Kanai K, Nakata M et al. Anti-GQ1b antibody does not affect neuromuscular transmission in human limb muscle. J Neuroimmunol 2007; 189(1–2): 158–162.

19. Lo YL, Leoh TH, Dan YF, Lim LL, Seah A, Fook--Chong S et al. Presynaptic neuromuscular transmission defect in the Miller Fisher syndrome. Neurology 2006; 66(1): 148–149.

20. Lange DJ, Deangelis T, Sivak MA. Single-fiber electromyography shows terminal axon dysfunction in Miller Fisher syndrome: a case report. Muscle Nerve 2006; 34(2): 232–234.

21. Tomcík J, Dufek M, Hromada J, Rektor I, Bares M. Recurrent Miller Fisher syndrome with abnormal terminal axon dysfunction: a case report. Acta Neurol Belg 2007; 107(4): 112–114.

22. Lo YL, Fook-Chong S, Chan LL, Ong WY, Ratnagopal P. Electrophysiological evidence of cerebellar fiber system involvement in the Miller Fisher syndrome. J Neurol Sci 2010; 288(1–2): 49–53.

23. Odaka M, Yuki N, Hirata K. Anti-GQ1b IgG anti­body syndrome: clinical and immunological range. Neurol Neurosurg Psychiatry 2001; 70(1): 50–55.

24. Tüzün E, Kürtüncü M, Lang B, İçöz S, Akman-Demir G, Eraksoy M et al. Bickerstaff’s encephalitis and Miller Fisher syndrome associated with voltage-gated potassium channel and novel anti-neuronal antibodies. Eur J Neurol 2010; 17(10): 1304–1307.

25. Ito M, Kuwabara S, Odaka M, Misawa S, Koga M, Hirata K et al. Bickerstaff’s brainstem encephalitis and Fisher syndrome form a continuous spectrum. Clinical analysis of 581 cases. J Neurol 2008; 255(5): 674–682.

26. Lee SH, Lim GH, Kim JS, Oh SY, Kim JK, Cha JK et al. Acute ophthalmoplegia (without ataxia) associated with anti-GQ1b antibody. Neurology 2008; 71(6): 426–429.

27. Fleury V, Aqallal A, Lagrange E, Besson G, Caudie C. Acute bilateral mydriasis associated with anti-GQ1b antibody. J Clin Neurosci 2010; 17(4): 514–515.

28. Špalek P, Martinka I, Jurčaga F, Richter D, Hanáčková E. Miller Fisherov syndróm – tri kazuistiky, diagnostika a liečba. Neurológia 2009; 4: 101–105.

29. Papanikolaou T, Gray C, Boothman B, Naylor G, Mariatos G. Acute bilateral ophthalmoparesis with pupilary areflexical mydriasis in Miller-Fisher syndrome treated with intravenous immunoglobulin. J Ophthalmol 2010; 2010: 291840.

30. Bae JS, Kim JK, Kim SH, Kim OK. Bilateral internal ophthalmoplegia as an initial sole manifestation of Miller Fisher syndrome. J Clin Neurosci 2009; 16(7): 963–964.

31. Fross RD, Daube JR. Neuropathy in the Miller Fisher syndrome: Clinical and electrophysiologic findings. Neurology 1987; 37(9): 1493–1498.

32. Hughes RA, Cornblath DR. Guillain-Barré syndrome. Lancet 2005; 366(9497): 1653–1666.

33. Dachy B, Deltenre P, Deconinck N, Dan B. The H reflex as a diagnostic tool for Miller Fisher syndrome in pediatric patients. J Clin Neurosci 2010; 17(3): 410–411.

34. Odaka M, Koga M, Yuki N, Susuki K, Hirata K. Longitudinal changes of anti-ganglioside antibodies before and after Guillain-Barré syndrome onset subsequent to Campylobacter jejuni enteritis. J Neurol Sci 2003; 210(1–2): 99–103.

35. Nishimoto Y, Odaka M, Hirata K, Yuki N. Usefulness of anti-GQ1b IgG antibody testing in Fisher syndrome compared with cerebrospinal fluid examination. J Neuroimmunol 2004; 148(1–2): 200–205.

36. Kiphuth IC, Saake M, Lunkenheimer J, Dörfler A, Schwab S, Kollmar R. Bilateral enhancement of the cranial nerves III–XII in severe Miller-Fisher syndrome. Eur Neurol 2009; 62(4): 252–253.

37. Lehmann HC, Hartung HP. Complementing the therapeutic armamentarium for Miller Fisher syndrome and related immune neuropathies. Brain 2008; 131(5): 1168–1170.

38. Mori M, Kuwabara S, Fukutake T, Hattori T. Plasmapheresis and Miller Fisher syndrome: analysis of 50 consecutive cases. J Neurol Neurosurg Psychiatry 2002; 72(5): 680.

39. Mori M, Kuwabara S, Fukutake T, Hattori T. Intravenous immunoglobulin therapy for Miller Fisher syndrome. Neurology 2007; 68(14); 1144–1146.

40. Overell JR, Hsieh ST, Odaka M, Yuki N, Willison HJ. Treatment for Fisher syndrome, Bickerstaff‘s brainstem encephalitis and related disorders. Cochrane Database Syst Rev 2007; 24(1): CD004761.

41. Bednařík J, Voháňka S, Ehler E, Ambler Z, Piťha J, Vencovský J et al. Standard pro léčbu pacientů s autoimunitními nervosvalovými onemocněními intravenózním lidským imunoglobulinem a plazmaferézou. Cesk Slov Neurol N 2010; 73/106(6): 579–589.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

Issue 6

2011 Issue 6

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