Back
 IJCM  Vol.8 No.3 , March 2017
A Patient with Post Infectious Immune Mediated Neuropathy (Miller Fisher Syndrome)
Abstract: The Miller Fisher variant is an uncommon but well known syndrome being described as a triad of areflexia, ataxia and complex ophthalmoplegia. It is characterized by antibodies against myelin that affects peripheral nerves, extraocular muscles and Schwann cells. Anti-ganglioside antibodies have been recognized in disease pathogenesis and decreasing antibody production is the mainstay of treatment. The course is usually benign with improvement after immunomodulation. This case report describes the approach to a patient suspected of having a demyelinating disorder. It delineates the subsets of immune mediated neuropathies in evaluating the diagnosis and emphasizes the need for early therapeutic intervention in achieving a good clinical outcome.
Cite this paper: Sanchez, S. and Esack, A. (2017) A Patient with Post Infectious Immune Mediated Neuropathy (Miller Fisher Syndrome). International Journal of Clinical Medicine, 8, 123-127. doi: 10.4236/ijcm.2017.83011.
References

[1]   Fisher, M. (1956) An Unusual Variant of Acute Idiopathic Polyneuritis (Syndrome of Ophthalmoplegia, Ataxia and Areflexia). The New England Journal of Medicine, 255, 57-65.
https://doi.org/10.1056/NEJM195607122550201

[2]   Berlit, P. and Rakicky, J. (1992) The Miller Fisher Syndrome. Journal of Clinical Neuro-Ophthalmology 12, 57-63.

[3]   Chiba, A., Kusunoki, S., Obata, H., et al. (1993) Serum Anti-GQ1b IgG Antibody Is Associated with Ophthalmoplegia in Miller Fisher Syndrome and Guillain-Barré Syndrome: Clinical and Immunohistochemical Studies. Neurology, 43, 1911-1917.
https://doi.org/10.1212/WNL.43.10.1911

[4]   Plomp, J.J., Molenaar, P.C., O’Hanlon, G.M., et al. (1999) Miller Fisher Anti-GQ1b Antibodies: Alpha-Latrotoxin-Like Effects on Motor End Plates. Annals of Neurology, 45, 189-199.
https://doi.org/10.1002/1531-8249(199902)45:2<189::AID-ANA9>3.0.CO;2-T

[5]   Jacobs, B.C., Bullens, R.W., O’Hanlon, G.M., Ang, C.W., Willison, H.J. and Plomp, J.J. (2002) Detection and Prevalence of Alpha-Latrotoxin-Like Effects of Serum from Patients with Guillain-Barré Syndrome. Muscle Nerve, 25, 549-558.
https://doi.org/10.1002/mus.10060

[6]   O’Hanlon, G.M., Plomp, J.J., Chakrabarti, M., et al. (2001) Anti-GQ1b Ganglioside Antibodies Mediate Complement-Dependent Destruction of the Motor Nerve Terminal. Brain, 124, 893-906.
https://doi.org/10.1093/brain/124.5.893

[7]   Halstead, S.K., O’Hanlon, G.M., Humphreys, P.D., et al. (2004) Anti-Disialoside Antibodies Kill Perisynaptic Schwann Cells and Damage Motor Nerve Terminals via Membrane Attack Complex in a Murine Model of Neuropathy. Brain, 127, 2109-2123.
https://doi.org/10.1093/brain/awh231

[8]   Chiba, A., Kusunoki, S., Obata, H., Machinami, R. and Kanazawa, I. (1997) Ganglioside Composition of the Human Cranial Nerves, with Special Reference to Pathophysiology of Miller Fisher Syndrome. Brain Research, 745, 32-36.
https://doi.org/10.1016/S0006-8993(96)01123-7

[9]   Willison, H.J. and Yuki, N. (2002) Peripheral Neuropathies and Anti-Glycolipid Antibodies. Brain, 125, 2591-2625.
https://doi.org/10.1093/brain/awf272

[10]   Jacobs, B.C., O’Hanlon, G.M., Bullens, R.W., Veitch, J., Plomp, J.J. and Willison, H.J. (2003) Immunoglobulins Inhibit Pathophysiological Effects of Anti-GQ1b-Positive Sera at Motor Nerve Terminals through Inhibition of Antibody Binding. Brain, 126, 2220-2234.
https://doi.org/10.1093/brain/awg235

[11]   Jacob, S. and Rajabally, Y.A. (2009) Current Proposed Mechanisms of Action of Intravenous Immunoglobulins in Inflammatory Neuropathies. Current Neuropharmacology, 7, 337-342.
https://doi.org/10.2174/157015909790031166

 
 
Top