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

Miller Fisher syndrome (MFS) is a rare disorder considered to be a clinical variant of Guillain-Barre 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.