What are the characteristics of the Miller-Fisher syndrome (MFS) subtype of Guillain-Barre syndrome (GBS)?

Updated: Jun 24, 2020
  • Author: Michael T Andary, MD, MS; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

Miller-Fisher syndrome (MFS), which is observed in about 5% of all cases of GBS, classically presents as a triad of ataxia, areflexia, and ophthalmoplegia. [19] Acute onset of external ophthalmoplegia is a cardinal feature. [12] Ataxia tends to be out of proportion to the degree of sensory loss. Patients may also have mild limb weakness, ptosis, facial palsy, or bulbar palsy. Patients have reduced or absent sensory nerve action potentials and absent tibial H reflex. [20]

Anti-GQ1b antibodies are prominent in MFS, and have a relatively high specificity and sensitivity for the disease. [21] Dense concentrations of GQ1b ganglioside are found in the oculomotor, trochlear, and abducens nerves, which may explain the relationship between anti-GQ1b antibodies and ophthalmoplegia. Patients with acute oropharyngeal palsy carry anti-GQ1b/GT1a IgG antibodies. [12] Recovery generally occurs within 1-3 months.


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