Steroid-Responsive Miller-Fisher Variant of Guillain-Barré Syndrome in a 25-year Old Male: A case report

ABSTRACT

Introduction@#Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome (GBS) characterized by an immunemediated polyneuropathy. Diagnosis is largely clinical and spontaneous recovery is observed in most cases. Treatment options such as IVIg, plasmapheresis, and steroids have been studied as options to shorten the disease course, but with inconclusive results. @*Case@#A 25-year-old male complained of sudden onset diplopia, gait instability and hand parasthesia. Diagnosis of MFS was done clinically; chest CT scan, nerve conduction studies, and MRI of brain and orbits were unremarkable. Anti-GQ1b determination was not performed. Low dose oral corticosteroid was initiated with gradual recovery of symptoms noted over two weeks and full recovery in two months.@*Discussion@#Miller Fisher syndrome (MFS) is a rare entity and the least common of the GBS variants. Its incidence as a proportion of GBS accounts for one to five percent in Western countries. Most patients have evidence of an upper respiratory tract infection one to three weeks before symptom onset. MFS is largely considered to be a self-limiting condition, but case series have shown that patients return to normal activities approximately six months after neurological onset. The patient in this report was treated with low dose steroids, with gradual taper over two months. Significant improvement of symptoms was noted over two months, which is shorter than the six months recovery in literature. @*Conclusion@#Worldwide incidence of MFS can be underestimated as it is often overlooked during the initial work-up of the disease. The risks of treatment, therefore, should be weighed against the likelihood of spontaneous recovery. Although use of steroids in this case report have noticeably caused a shorter course of the disease, prospective studies are suggested to look into the role of low dose oral corticosteroids in shortening the onset-to-recovery course of this illness.