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Miller Fisher syndrome: symptoms, causes and treatment

Miller Fisher syndrome: symptoms, causes and treatment

July 19, 2024

Guillain-Barré syndrome is an autoimmune disease that mainly affects the movements of muscles and can manifest itself through many variants.

In this article we will analyze the symptoms, causes and treatment of Miller Fisher syndrome , one of the most frequent forms of this disorder.

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What is Miller Fisher syndrome?

Miller Fisher syndrome is a disease that affects the nervous system, causing symptoms associated with muscular motor and coordination . In some cases it can cause alterations also in other physiological systems.


It is one of the possible manifestations of Guillain-Barré syndrome, a set of diseases that occurs as a result of infections that in turn cause an inadequate functioning of the immune system.

The Miller Fisher syndrome generally has a good prognosis: if proper medical treatment is applied the symptoms tend to remit completely . However, this is not always the case, and if the damage to the nervous system is significant, some sequelae may remain.

Approximately twice as many cases of Miller Fisher syndrome are detected in women as in men, and the prevalence is higher in the spring than in the rest of the year. The average age of onset of the disease is somewhat above 40 years.


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Guillain-Barré syndrome

Guillain-Barré syndrome is an autoimmune disorder ; This means that it consists of a malfunction of the immune system that leads to "attack" healthy cells of the body. In this case the lesions take place in the peripheral nervous system, affecting first the muscles of the extremities, and sometimes leading to complete paralysis.

In the most severe cases, this disease causes death due to the alteration in the functioning of the cardiac and respiratory systems. It is usually caused by viral infections, although the mechanisms by which it is produced are not known exactly.

The differential diagnosis between Miller Fisher syndrome and the other variants of Guillain-Barré syndrome is carried out according to the presence of characteristic signs and symptoms. Let's see what are the peculiarities of the subtype that concerns us.


Symptoms and main signs

There are three essential signs that characterize Miller Fisher syndrome compared to other forms of Guillain-Barré syndrome: ataxia, areflexia and ophthalmoplegia . These alterations usually appear between 5 and 10 days after a viral infection is contracted.

Ophthalmoplegia and ataxia are usually the first signs of the disease. The first consists of the paralysis of the muscles of the eyeball, while Ataxia is defined as a loss of motor coordination . For its part, areflexia, which occurs in third place and mainly in the extremities, is the absence of reflex movements.

The other idiosyncratic feature of this variant of Guillain-Barré syndrome is the involvement of the cranial nerves, which is associated with deficits in nerve conduction.

In some cases, other alterations associated with the same injuries occur, mainly generalized muscle weakness and respiratory deficits , which can lead to death if the symptoms are very intense. However, these problems are more common in other forms of Guillain-Barré syndrome.

Causes of this disease

Although Miller Fisher syndrome is usually attributed to infections by viruses (and to a lesser extent also by bacteria), the truth is that it has not been possible to demonstrate that these are the only possible cause of this disease.

The signs and symptoms are due to the destruction of peripheral nerve myelin sheaths by the immune system. Myelin is a lipid substance that lines the axons of some neurons, allowing the efficient transmission of nerve impulses and increasing their speed.

However, alterations have also been detected in the central nervous system, specifically in the posterior part of the spinal cord and in the trunk of the brain.

On the other hand it has been found the antibody antiganglioside immunoglobulin GBQ1b in most people with the diagnosis of Miller Fisher syndrome. This antibody appears to be particularly associated with the presence of ophthalmoplegia.

Treatment and management

Like the other variants of Guillain-Barré syndrome, Miller Fisher disease is treated by two procedures: plasmapheresis, which involves removing antibodies from the blood by filtration, and administration of immunoglobulins intravenously.

Both techniques are very effective in neutralizing the effects of pathological antibodies and in reducing inflammation, which also causes damage to the nervous system, but combining them does not significantly increase the probability of success of the intervention. But nevertheless, the administration of immunoglobulins carries less risk .

Most people start to recover after two weeks and one month of treatment, as long as it is applied early. After six months the symptoms and signs are usually nil or very scarce, although sometimes there may be sequelae and there is a 3% risk of re-emerging after disappearing.


Guillain Barre Syndrome Web (July 2024).


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