Surge of Miller Fisher variant and Guillain-Barré syndrome in two downtown Los Angeles community teaching hospitals

Amyotrophic lateral sclerosis in a patient who recovered from Miller Fisher Syndrome: The role of GQ1b antibody revisited

Miller Fisher Syndrome (MFS), a variant of Guillain Barre Syndrome (GBS), and amyotrophic lateral sclerosis (ALS) are two rare neuromuscular diseases that are usually unrelated. While ganglioside antibodies have a common relation with MFS and GBS, they have also been found in association, albeit less commonly, with ALS. A patient experiencing MFS and then ALS in tandem has never been documented. We discuss a case demonstrating these findings, with GQ1b elevated on both occasions. The pathophysiologic role of GQ1b is explored.

GM1 ganglioside antibody and COVID-19 related Guillain Barre Syndrome - A case report, systemic review and implication for vaccine development

Background

Guillain Barre Syndrome (GBS) and Miller Fisher Syndrome (MFS) are emerging as known consequences of COVID-19 infection. However, there have been no reported cases with positive GM1 or GQ1b antibodies in the literature to date. Although clinically similar, the pathophysiology of COVID-19 related GBS and MFS may be significantly different from cases in the pre-pandemic era.

Case presentation

We present a patient with ascending areflexic weakness consistent with GBS with positive GM1 antibody. The patient had recovered from COVID-19 infection two weeks prior with mild viral illness and symptoms. Her weakness was isolated to the lower extremities and improved after intravenous immunoglobulin treatment. Patient recovered eventually.

Conclusions

– The general lack of reported ganglioside antibodies supports a novel target(s) for molecular mimicry as the underlying etiology, which raises the concern for possible vaccine induced complication. Whether the current GM1 positive case is a sequalae of COVID-19 or a mere coincidence is inconclusive. Further understanding of the disease mechanism of pandemic era GBS and MFS, including antigen target(s) of COVID-19, may be of utmost importance to the development of a safe COVID-19 vaccine.

Miller Fisher Syndrome in the COVID-19 Era - A Novel Target Antigen Calls for Novel Treatment

Although Miller Fisher syndrome cases have been published in this coronavirus disease 2019 (COVID-19) pandemic, anti-GQ1b antibody has not been identified so far. A direct proof of association is not yet available since the exact pathophysiology is not known. Using a proof of contradiction argument, lack of GQ1b serves as the indirect proof that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is probably the infection preceding demyelination. A novel antigen has yet to be described.