Miller-Fisher Syndrome at King Chulalongkorn Memorial Hospital
Praween Lolekha MD*, Kammant Phanthumchinda MD**
Affiliation : * Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasart University Hospital, Pathum Thani, Thailand ** Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Miller-Fisher syndrome (MFS), a variant of Guillain-Barré syndrome (GBS) is a self-limiting
demyelinating disease of the peripheral nervous system. Clinical spectrum, natural history, prognosis, and
pathogenesis of MFS are not fully documented.
Objective : Probe the clinical features of MFS in a tertiary center in Thailand and compare its pattern with
other Asian countries.
Material and Method: The clinical recordings were searched from databases at King Chulalongkorn
Memorial Hospital (KCMH) between 2002 and 2007. Keywords were “Miller-Fisher syndrome” and “Guillain-
Barré syndrome”. Cases with MFS were recruited. The data regarding clinical features, course, treatments,
and investigations were reviewed. Comparisons with other large Asian series were demonstrated.
Results : Six patients (male: female; 3:3) with MFS were analyzed. The incident rate is 7.7% that of GBS.
The median age was 54.3 years (range 28 to 73 years). MFS frequently started with diplopia followed by
ophthalmoplegia and ataxia. Other clinical symptoms included limb dysesthesia and weakness, dysphagia,
dysarthria, and diffuse headache. Spontaneous recovery occurred in three patients while two patients
received plasmapheresis and one received intravenous immunoglobulin (IVIG). Six months after neurological
deficits, all patients were almost free of symptoms and had returned to their normal activities.
Conclusion : The incidence, clinical features, and prognosis of MFS in KCMH were comparable with the
previous studies in other Asian countries. High percentage of limb dysesthesia and optic neuropathy were
detected in the present series. Headache was also common among Thai MFS. Immuno-pathogenesis of MFS is
well documented but immunomodulatory therapy should be considered only in some cases.
Keywords : Miller-Fisher syndrome, Guillain-Barré syndrome
