Abstract
Objective: Miller Fisher syndrome (MFS) is predominantly a clinical diagnosis, with classic triad of ophthalmoplegia, ataxia, and generalized reduced reflexes. Previous studies in chronic and acute immune-mediated neuropathies indicated that ultrasound, may help to detect changes that could correspond with disease activity. We studied the feasibility of serial nerve ultrasound in MFS, using a healthy controls.Methods: All MFS patients (n = 5) and healthy controls (n = 18), underwent a standardized sonographic protocol that evaluated nerve sizes of facial, large arm and leg nerves, and spinal nerve roots. All MFS patients underwent routine ancillary investigations, including electrodiagnostic testing and for presence of anti-GQ1b antibodies. In addition, four MFS patients had 2nd, and 3rd clinical and sonographic evaluation at 14 and 90 days from onset.Results: The width of the facial nerve was significantly larger in the MFS group than in the control group (MFS: 1.19 ± 0.31 mm vs. normal: 0.67 ± 0.13 mm, P = 0.01). The size of the cervical roots and the nerves in the limbs were similar between the two groups. Two patients' facial nerve size subsided with time, but the decrease in other nerves' sizes were not obvious.Conclusion: Our study showed that serial nerve ultrasound studies are feasible in MFS, and can capture changes in facial nerve size that could complement routine diagnostic tests. Further studies are warranted to determine and compare its test characteristics in MFS.
Highlights
Miller Fisher syndrome (MFS) is a variant of Guillain-Barre syndrome (GBS)-spectrum disorder, which is a post-infectious monophasic neuropathy [1]
There were 19 patients with GBS-spectrum disorders between January 1, 2018, and December 31, 2018, and there were 5 patients fulfilling the criteria for MFS
The cross-sectional area (CSA) of the nerves in the limbs were similar between the two groups
Summary
Miller Fisher syndrome (MFS) is a variant of Guillain-Barre syndrome (GBS)-spectrum disorder, which is a post-infectious monophasic neuropathy [1]. The incidence of GBS is between 1.1 and 1.8/100,000/year [2]. There are several GBS spectrum disorder variants (acute inflammatory demyelinating polyradiculoneuropathies, acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, and MFS), with distinct geographic distribution of prevalence. The proportion of MFS in the GBS spectrum disorder is higher in Asia (18–26%) than in Western countries (3–5%) [2, 3]. Limb paresthesia and facial palsy are not uncommon in pure MFS [1, 4], and MFS could occasionally overlap with another variant of GBS, such as the pharyngeal-cervical-brachial variant [1, 5]
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