Miller Fisher syndrome is a nodo-paranodopathy, but not a myelinopathy

ABSTRACT

Miller Fisher syndrome, characterized by ophthalmoplegia, ataxia and areflexia, is a variant of Guillain–Barré syndrome. There have been controversies over the electrophysiological studies of Miller Fisher syndrome, as both demyelinating and axonal changes have been reported. In recent years, reversible conduction failure has been reported in patients with Miller Fisher syndrome with the use of serial nerve conduction studies. The similarity between Miller Fisher syndrome and axonal Guillain–Barré syndrome has led to the suggestion of a common autoimmune mechanism at the nodes and paranodes.

KEYWORDS:

• anti-GQ1b antibody
• demyelination
• Guillain–Barré syndrome
• Miller Fisher syndrome
• myelinopathy

Financial & competing interests disclosure

N Yuki receives grant support from the Singapore National Medical Re-search Council (IRG 10nov086 and CSA/047/2012 to N Yuki), and serves as an editorial board member of Expert Review of Neurotherapeutics, The Journal of the Neurological Sciences, The Journal of Peripheral Nervous System and Journal of Neurology, Neurosurgery & Psychiatry. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Acknowledgements

The authors would like to thank Dr Nortina Shahrizaila, Division of Neurology, Department of Medicine, University of Malaya, Malaysia, for the critical reading and comments to the review, and Dr Thirugnanam Umapathi, Department of Neurology, National Neuroscience Institute, Singapore, for providing the figures on serial nerve conduction studies.