Miller-Fisher Syndrome: Causes, Symptoms & Treatment

Miller-Fisher syndrome is the name given to an insidious infectious disease that both disrupts movement and can also affect the speech center. The nerves as well as nerve roots are destroyed by inflammation as part of Miller-Fisher syndrome; as a result, many affected individuals are also dependent on a wheelchair.

What is Miller-Fisher syndrome?

The medical profession refers to Miller-Fisher syndrome as a rare condition that primarily affects the peripheral nervous system. Usually, the syndrome attacks the patient’s cranial nerves. The disease was named after Charles Miller Fisher, a Canadian neurologist. It should be noted that Miller-Fisher syndrome is a variant of the so-called Guillain-Barré syndrome. Depending on the course of the disease, the therapy is oriented; often, 14 days after Miller-Fisher syndrome there are no more symptoms, but sometimes a rehabilitation period may be necessary to get rid of all restrictions.

Causes

So far, medical experts face an unexplained mystery as to why Miller-Fisher syndrome can occur. However, experts believe that Miller-Fisher syndrome is an autoimmune disease that can occur after a viral infection. The reasons why and why not are not known.

Symptoms, complaints, and signs

While Guillain-Barré syndrome paralyzes the entire body muscles, Miller-Fisher syndrome initially still manifests with eye movement disorders. Sometimes, however, a reflex loss of the muscles (areflexia) can also be observed. Due to the disorders, which mainly affect the eye movements, the patient complains of double vision. The affected person can neither control the eye movement, nor can impulses flowing from the brain stem via the nerves directly to the eye muscles be transmitted. Even if the loss of the muscle reflexes is noticed, there is no typical impairment that limits the patient or leads to the occurrence of a disease state. The affected person subsequently complains of disturbances in the target movements of his legs and arms or also of the trunk, so that balance disturbances can sometimes also occur. According to statistics, every sixth patient suffers from bladder dysfunction. The severity of the disorders of target movements plays an essential role in the context of therapy.

Diagnosis and course of the disease

If eye muscle disorders occur, the physician must also take any other brainstem disorders into consideration. Thus, in addition to Miller-Fisher syndrome, strokes, botulism, or circulatory disorders, for example, are also possible. For this reason, the treating physician initially concentrates on the slice examination of the brain stem. In doing so, he uses a computer tomogram (CT) or a magnetic resonance imaging (MRI). Any ultrasound examinations of the arteries supplying the brain can also provide information as to whether Miller-Fisher syndrome is present. Subsequently, neurophysiological examinations are used to examine the functions of the brain stem. In the process, the special nerve tracts can be checked for their potential. The physician then examines the cerebrospinal fluid (CSF). This shows an enormous increase in protein content, but only a slight increase in the number of detectable cells, so that one must speak of a cytoalbuminic dissociation. Furthermore, special antibodies can be detected in the blood. Thus, in Miller-Fisher syndrome, antibodies against the so-called GQ1b ganglioside can be detected. A prognosis cannot be made; the course of the disease can vary to such an extent that all symptoms have disappeared after only 14 days, but the problem can also arise that actually lasting damage remains. However, the patient must be aware that, as a rule, he or she will have to undergo a long period of rehabilitation in order for all the disturbances that have occurred in the course of Miller-Fisher syndrome to be relieved.

Complications

Miller-Fisher syndrome causes paralysis in various regions of the body. In most cases, the eyes are primarily affected, so that the affected person can no longer move them. Other visual complaints, double vision and so-called veil vision also occur. The patient’s quality of life is significantly reduced and limited by Miller-Fischer syndrome.In most cases, the legs can also no longer be moved, or only to a very limited extent, resulting in restricted movement and other limitations in everyday life. Furthermore, disturbances of balance and coordination also occur, so that those affected are not infrequently dependent on the help of other people in their daily lives. Furthermore, a stroke or other disturbances of the blood circulation may occur. Not infrequently, the complaints of Miller-Fischer syndrome occur permanently and do not disappear again. In this case, these complaints can usually not be removed even by treatment. The treatment itself can be very limited and depends on different therapies. Not infrequently, psychological treatments are also necessary to prevent or treat depression and other moods. Whether Miller-Fischer syndrome causes a reduction in life expectancy cannot be predicted in general.

When should you see a doctor?

A general feeling of malaise, a feeling of illness, and a decrease in internal strength indicate a health imbalance. If the complaints persist or further disturbances occur, a physician should be consulted. Abnormalities of eye movements or peculiarities of vision should be examined and treated. In many cases, there is perception of double vision or decreased vision. Reflex loss of the muscles is alarming and should be presented to a physician immediately. If eye movements can no longer be regulated voluntarily or if a loss of intrinsic reflexes occurs, a physician must be consulted. Irregularities in general movements are also worrisome and should be clarified by a physician. If the affected person has no control over the voluntary movement of arms and legs, he or she needs medical help. If locomotion is difficult or there are motor function disturbances, a physician should be consulted. If the general risk of accidents and injuries increases due to the inconsistencies in movement, a visit to the doctor should be made. If daily activities can no longer be performed as usual, if the quality of life is reduced, or if the patient’s sense of well-being declines, a doctor should be consulted. Gait unsteadiness and disturbances of balance are further indications of a health impairment. Behavioral abnormalities, mood changes and withdrawal behavior should also be discussed with a physician.

Treatment and therapy

The treatment of Miller-Fisher syndrome also depends on the course of the disease. In severe cases, the physician treats the patient with immunoglobulins or plasmapheresis. Plasmapheresis treatment is a type of blood washing that removes the immunoglobulins and antibodies responsible for Miller-Fisher syndrome from the blood. Usually, the affected person receives two to four treatments; after that, the blood should be cleansed of the antibody. The causal treatment is followed by therapy; if the patient has difficulties with his movements, these must be treated and trained in such a way that an independent life is possible again and sometimes any aids – such as a wheelchair – can be dispensed with in the long term. The therapy is effective when a team of doctors, occupational therapists, speech therapists and physiotherapists as well as psychologists and social workers can be found to care for the patient. This is because rehabilitation is often necessary after Miller-Fisher syndrome, with the focus on ataxia – the disturbance of target movements. By means of physiotherapy, the patient learns that he can perform his movements accurately again. In the course of physiotherapy, the patient learns again to correct any disturbances in walking or standing. Occupational therapy, on the other hand, deals primarily with fine motor disorders. It is important that there is precise coordination between the groups within the framework of the therapies. Thus, the physiotherapists should be very well informed about which units have been carried out by the occupational therapist. The occupational therapist mainly takes care that the patient – after very severe cases – manages to wash, eat as well as get dressed independently again and is supported in his everyday situations. At the end of rehabilitation, the patient should no longer have any permanent damage. Depending on the clinical picture, further therapeutic measures can also be taken.

Outlook and prognosis

The prognosis for Miller-Fisher syndrome is usually very good if the cause is known and curable. Because it is mostly a result of infection, elimination of the infection will also lead to gradual recovery of the nerves. The failed or impaired body functions may return within a few months, with no further damage or other consequences expected. In some cases, however, motor disturbances remain. These can be addressed with physical therapy or occupational therapy, which has a very high chance of success. Miller-Fisher syndrome is very rarely associated with completely irreparably damaged nerves. What is relevant, as with all syndromes or diseases that affect nerve function, is early diagnosis. This leads to early treatment. If the symptoms are not recognized correctly or are misclassified, the prognosis can worsen considerably due to incorrect treatment. In a few cases, Miller-Fisher syndrome may also affect respiration, making the patient’s prognosis very poor. However, in such cases, other diseases of the nerves are also often involved.

Prevention

Because no cause is yet known as to which factors promote Miller-Fisher syndrome, no preventive measures can be recommended. Therefore, Miller-Fisher syndrome cannot be prevented.

Follow-up

Miller-Fisher syndrome can lead to various complications that can have a very negative impact on the quality of life of the affected person. In general, therefore, a doctor should be consulted at an early stage to prevent further worsening of the symptoms. Most of those affected suffer from eye movement disorders as a result of this syndrome. There is usually an uncontrolled movement and often a loss of control over the eye muscles. Often, the syndrome also leads to developmental disorders in children, so that they may also suffer from depression or other psychological upsets. Especially in childhood, Miller-Fisher syndrome often leads to bullying. Disturbances of balance sometimes occur, and most patients cannot control the bladder properly. The legs can also not be moved purposefully, so that there may be restrictions in movement. If the syndrome is not treated, it can also lead to a stroke, which may significantly reduce the life expectancy of the affected person. The further course depends very much on the cause of the disease, so that a general prediction is not possible.

This is what you can do yourself

Miller-Fisher syndrome requires medical diagnosis and treatment in all cases. Medical therapy can be supported by a number of self-help measures. The most important measure is to avoid nicotine and alcohol during and before therapy, as these substances may cause problems with blood washing. The doctor will tell the patient how to eat before the plasmapheresis treatment, thus enabling a symptom-free therapy. After the treatment, comprehensive follow-up care is needed. In addition, the patient must perform physiotherapy exercises on a regular basis to improve movement patterns and correct any problems with standing or walking. In the context of occupational therapy, mainly the fine motor disorders are treated. The patient can support these measures at home by performing exercises recommended by the doctor or therapist. In severe cases, the affected person must also relearn normal routines and activities such as washing or dressing. This is where the relatives are most needed, and they must be on hand to provide supportive assistance. It may be necessary to organize aids such as crutches or a wheelchair, as well as a facility suitable for the disabled.