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Ishii J, Yuki N, Kawamoto M, Yoshimura H, Kusunoki S, Kohara N. Recurrent Guillain-Barré syndrome, Miller Fisher syndrome and Bickerstaff brainstem encephalitis. J Neurol Sci 2016; 364:59-64. [PMID: 27084218 DOI: 10.1016/j.jns.2016.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Guillain-Barré syndrome (GBS), Miller Fisher syndrome (MFS), and Bickerstaff brainstem encephalitis (BBE) are usually monophasic, but some patients experience recurrences after long asymptomatic intervals. We aimed to investigate clinical features of recurrent GBS, MFS, and BBE at a single hospital. METHODS Records from 97 consecutive patients with GBS, MFS or BBE who were admitted to a tertiary hospital between 2001 and 2013 were reviewed. Clinical and laboratory features of patients with recurrent GBS, MFS, or BBE were investigated. RESULTS Patients included 55 (32 males) with GBS, 34 (22 males) with MFS, and 8 (6 males) with BBE. Recurrent cases occurred in 2 (4%) of the 55 patients with GBS, 4 (12%) of the 34 patients with MFS, and 2 (25%) of the 8 patients with BBE. Patients with recurrent MFS had a tendency to be younger at the first episode than patients with non-recurrent MFS (median, 22 versus 37years old). Symptoms and signs were less severe during relapses than during the initial episode in recurrent patients. CONCLUSIONS Recurrences occurred more frequently in patients with MFS or BBE compared with those with GBS. Patients with recurrent MFS might be younger than those with non-recurrent MFS.
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Affiliation(s)
- Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
| | - Nobuhiro Yuki
- Brain and Mind Centre, University of Sydney, Australia.
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
| | - Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
| | - Susumu Kusunoki
- Department of Neurology, Kinki University School of Medicine, Japan.
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
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Toru S, Ohara M, Hane Y, Ishiguro T, Kobayashi T. Successful steroid treatment for recurrent Miller Fisher syndrome. Muscle Nerve 2012; 45:763-4. [PMID: 22499109 DOI: 10.1002/mus.23257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
To present two patients with Miller Fisher syndrome (MFS) recurrence after 35 and 44 years and review of the literature on recurring MFS. All identified cases with recurrent MFS were evaluated. Age, gender, clinical features of first and recurrent MFS, course of disease, laboratory findings, therapy and outcome were transformed into tables. Twenty-eight patients (16 men, 12 women; mean age at the first episode 34 years (range 13-57 years); mean age at the latest episode 47 years (range 21-66 years) with a total of 70 MFS episodes were identified. Twenty-one patients had a single recurrence, five patients had two recurrences, one patient had four recurrences and one patient had seven recurrences. The mean interval between attacks was 9.45 years (3 months to 44 years). In 76% of the initial episodes and in 81% of the recurrent episodes, an infectious disease preceded MFS. Additional facial and bulbar symptoms and autonomic disturbances were frequent findings. Cerebrospinal fluid (CSF) and electrodiagnostic findings were unspecific. If tested, autoantibodies against GQ1b had been positive in all episodes. In about half of the patients, immunotherapy was applied. The outcome was favourable in most patients. Recurrence of MFS is a rare quite uniform condition with a mostly favourable prognosis.
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Affiliation(s)
- J G Heckmann
- Department of Neurology, Klinikum Landshut, Robert-Koch-Strasse 1, Landshut, Germany.
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Abstract
The Miller Fisher syndrome (MFS), characterized by ataxia, areflexia, and ophthalmoplegia, was first recognized as a distinct clinical entity in 1956. MFS is mostly an acute, self-limiting condition, but there is anecdotal evidence of benefit with immunotherapy. Pathological data remain scarce. MFS can be associated with infectious, autoimmune, and neoplastic disorders. Radiological findings have suggested both central and peripheral involvement. The anti-GQ1b IgG antibody titer is most commonly elevated in MFS, but may also be increased in Guillain-Barré syndrome (GBS) and Bickerstaff's brainstem encephalitis (BBE). Molecular mimicry, particularly in relation to antecedent Campylobacter jejuni and Hemophilus influenzae infections, is likely the predominant pathogenic mechanism, but the roles of other biological factors remain to be established. Recent studies have demonstrated the presence of neuromuscular transmission defects in association with anti-GQ1b IgG antibody, both in vitro and in vivo. Collective findings from clinical, radiological, immunological, and electrophysiological techniques have helped to define MFS, GBS, and BBE as major disorders within the proposed spectrum of anti-GQ1b IgG antibody syndrome.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Outram Road, 169608 Singapore.
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Battaglia F, Attane F, Robinson A, Martini L, Siboni J, Tannier C. Syndrome de Miller-Fisher récidivant. Rev Neurol (Paris) 2005; 161:844-7. [PMID: 16244569 DOI: 10.1016/s0035-3787(05)85146-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Miller-Fisher syndrome (MFS) is a rare auto-immune post-infectious syndrome, characterized by an ataxia, an ophthalmoplegia and a generalized areflexia. It is considered as a clinical variant of Guillain-Barré syndrome (GBS). MFS is correlated with the presence of anti-GQ1b antibodies, elevated cerebrospinal fluid (CSF) protein levels, presence of mostly sensitive electrophysiological abnormalities and for some authors central involvement with increased signal intensity of brainstem and cerebellum on MRI. Recurrent MFS is extremely rare with only 21 cases since the first description in 1970. CASE REPORT A 54-year-old women presented MFS with two episodes in 19 years. Clinically, the first episode was a "classical" MFS, and the second an extensive MFS with tetraparesis and respiratory failure. CSF protein levels and cerebral MRI were normal. Anti-GQ1b antibodies were strongly positive and anti-GM1, anti-GM2 antibodies were slightly positive, campylobacter jejuni serology was negative. Electromyography showed isolated sensory abnormalities in median nerves territory. CONCLUSION We report a new case of recurrent MFS with unusual clinical, biological and electrophysiological features.
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Affiliation(s)
- F Battaglia
- Service de Neurologie, Centre Hospitalier A. Gayraud, Carcassonne.
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Orr CF, Storey CE. Recurrent Miller–Fisher syndrome. J Clin Neurosci 2004; 11:307-9. [PMID: 14975425 DOI: 10.1016/j.jocn.2003.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2002] [Accepted: 03/12/2003] [Indexed: 10/26/2022]
Abstract
A case of recurrent Miller-Fisher syndrome is presented and features of this very rare condition are discussed.
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Affiliation(s)
- C F Orr
- Department of Neurology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
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Chida K, Nomura H, Konno H, Takase S, Itoyama Y. Recurrent Miller Fisher syndrome: clinical and laboratory features and HLA antigens. J Neurol Sci 1999; 165:139-43. [PMID: 10450799 DOI: 10.1016/s0022-510x(99)00095-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In rare cases, Miller Fisher syndrome (MFS) has been known to recur. However, clinical features of recurrent MFS have not been well analyzed, and the precipitating factors relating to recurrence remain unknown. From 1981 to 1996, we examined four patients with recurrent MFS among 28 Japanese MFS patients. In the four patients, the recurrent episodes occurred after long asymptomatic intervals, ranging from 2.5 to 12.5 years. The clinical and laboratory features of recurrent episodes were similar either to those of the initial episodes or to those of the 24 non-recurrent patients. Of the two patients tested for serum IgG anti-GQ1b antibody, both were positive. Serological HLA typing showed that all recurrent patients were both HLA-Cw3 and -DR2 positive. However, out of 13 non-recurrent patients examined, six had HLA-Cw3, and four had HLA-DR2. The frequency of HLA-DR2 among the recurrent patients was significantly higher than among healthy controls (corrected P = 0.038), and was also higher than among the non-recurrent patients but not significantly. These findings suggest that recurrent MFS is clinically the same as typical MFS and that HLA-DR2 is possibly associated with recurrence.
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Affiliation(s)
- K Chida
- Department of Neurology, Kohnan Hospital, Sendai, Japan
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Trojaborg W. Acute and chronic neuropathies: new aspects of Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy, an overview and an update. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1998; 107:303-16. [PMID: 9872432 DOI: 10.1016/s0013-4694(98)00096-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
During the last 15 years new information about clinical, electrophysiological, immunological and histopathological features of acute and chronic inflammatory neuropathies have emerged. Thus, the Guillain-Barré syndrome (GBS) is no longer considered a simple entity. Subtypes of the disorder besides the typical predominant motor manifestation, are recognized, i.e. a cranial nerve variant with ophthalmoplegia, ataxia and areflexia, an immune-mediated primary motor axonal neuropathy (AMAN), and a motor-sensory syndrome (AMSAN). Also, the clinical pattern of GBS is related to preceding viral or bacterial infections. Two types of acute motor paralysis have been described, one with slow and incomplete recovery, another with recovery times identical with acute inflammatory demyelinating polyneuropathy (AIDP). Histologically, the first is characterized by Wallerian degeneration of motor roots and peripheral motor nerve fibres. In the latter anti-GM antibodies bind to the nodes of Ranvier producing a failure of impulse transmission. Motor-point biopsies have shown denervated neuromuscular junctions and a reduced number of intramuscular nerve fibres. Molecular mimicry has been postulated as a possible mechanism triggering GBS. Thus, in the cranial variant antibodies to ganglioside GQ1b recognizes similar epitopes on Campylobacter jejuni strains and similar observations apply to anti-GM1 antibodies. Chronic inflammatory demyelinating polyneuropathy (CIDP) also has several different clinical presentations such as a pure motor syndrome, a sensory ataxic variant, a mononeuritis multiplex pattern, relapsing GBS, and a paraparetic subtype. Each of the acute and the subtypes have different, more or less distinct, electrophysiologic and pathological findings. Instructive patient stories are presented together with there electrophysiologic and biopsy findings.
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Affiliation(s)
- W Trojaborg
- Institute of Neurology, Columbia Presbyterian Medical Center, Columbia University, New York, NY 10032, USA
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Riche G, Caudie C, Vial C, Bourrat C. [Recurrent Miller Fisher syndrome and anti-GQ1b antibodies]. Rev Med Interne 1998; 19:192-5. [PMID: 9775140 DOI: 10.1016/s0248-8663(97)80719-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Miller-Fisher syndrome is defined by the triad: ophthalmoplegia, ataxia and areflexia. This rare entity is generally regarded as a variant of the Guillain-Barré syndrome, although neurophysiological patterns differ. In the acute phase of the disease, sera of affected patients contain high titers of antiganglioside anti-GQ1b, which is a specific marker. Recurrences are exceptional. EXEGESE We report the case of a man with three recurrences of Miller-Fisher syndrome within 16 years. Anti-GQ1b antibody titers were elevated during an episode, decreasing but not completely and vanishing 2 years later. Intravenous human immunoglobulin treatment probably accelerated improvement at the two last episodes. CONCLUSIONS Some experimental and immunohistochemical data from the literature argue for a probable direct pathogenic role of antibodies against GQ1b ganglioside in this syndrome. This should be a rationale for the use of immunomodulating treatments.
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Affiliation(s)
- G Riche
- Service de neurologie A, hôpital neurologique et neurochirurgical Pierre-Wertheimer, Lyon, France
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al-Din SN, Anderson M, Eeg-Olofsson O, Trontelj JV. Neuro-ophthalmic manifestations of the syndrome of ophthalmoplegia, ataxia and areflexia: a review. Acta Neurol Scand 1994; 89:157-63. [PMID: 8030396 DOI: 10.1111/j.1600-0404.1994.tb01654.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Controversy regarding the nosological position of the syndrome of ophthalmoplegia, ataxia and areflexia (Miller Fisher syndrome) exists. The oculomotor dysfunction was presumed to represent an unusually symmetrical peripheral cranial nerve dysfunction. To investigate the neuro-ophthalmic manifestations in this rare syndrome we reviewed 109 reports describing 243 cases. The ophthalmoplegia was remarkable in its constant association with a cerebellar type ataxia. It was described to be remarkably symmetrical at all stages of development and recovery. From the early description of the syndrome by Fisher the ophthalmoplegia was observed to evolve as a symmetrical failure of upgaze followed by loss of lateral gaze and last by downgaze, recovery develops in the opposite pattern. Despite the severe nature of the ophthalmoplegia, 58 patients were reported to have sparing of downgaze and 192 (79%) had relative sparing of the eye lids. Active lid retraction and preserved Bell's phenomenon, despite upgaze paralysis, were described in 22 and 15 patients respectively. Upper lid jerks were described in 2, Parinaud's syndrome in 2, convergence spasm in 6, internuclear ophthalmoplegia in 15 and horizontal dissociated nystagmus in 11. Interestingly 23 were reported to present with paralysis of abduction progressing to lateral gaze paralysis and 5 had paralysis of abduction and contralateral gaze paralysis. Four had defective vestibulo-ocular reflex despite recovery of upgaze, 10 had central type nystagmus including rotatory, retractory and rebound nystagmus. Relative preservation of optokinetic nystagmus and preservation of vestibulo-ocular reflex despite an otherwise complete ophthalmoplegia were reported in 6 and 2 patients respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S N al-Din
- Department of Medicine, Jordan Medical College
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Zifko U, Drlicek M, Senautka G, Grisold W. High dose immunoglobulin therapy is effective in the Miller Fisher syndrome. J Neurol 1994; 241:178-9. [PMID: 8164023 DOI: 10.1007/bf00868348] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Ferrer X, Ellie E, Larrivière M, Deleplanque B, Lagueny A, Julien J. Late central demyelination after Fischer's syndrome: MRI studies. J Neurol Neurosurg Psychiatry 1993; 56:698-9. [PMID: 8509787 PMCID: PMC489623 DOI: 10.1136/jnnp.56.6.698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The case of a patient who presented with clinical, electrophysiological, and MRI evidence of central demyelination is described. The patient had been admitted to hospital for Fischer's syndrome a few years previously. The association of these two events suggests that central and peripheral myelinopathy may be related in Fischer's syndrome.
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Affiliation(s)
- X Ferrer
- Department of Neurology, Hôpital du Haut-Lévèque, Pessac, France
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Burbaud P, Neau JP, Agbo C, Rosolacci T, Gil R. [Late recurrence of Miller-Fischer syndrome. Physiopathogenic reflections about a case]. Rev Med Interne 1991; 12:215-6, 218. [PMID: 1896715 DOI: 10.1016/s0248-8663(05)83176-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The physiopathology of the syndrome of ophtalmoplegia-ataxia-areflexia-hyperproteinorachia, firstly described by FISHER in 1956, remains a matter of controversy among neurologists. We report a new case of recurrence of a MILLER-FISHER's syndrome. The involvement of peripheral and central structures is discussed according to recent knowledges about the immunopathology of inflammatory polyneuropathies.
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Affiliation(s)
- P Burbaud
- Clinique Neurologique, CHU La Milétrie, Poitiers
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