Hi.

Alan comes over to me and says: "I don't think I have CIDP, I think I have Miller Fisher". Now I had never heard of this and I looked at him and I said "You've been watching HOUSE again haven't you"??? He laughed.

So I googled this and here's what came up:

Miller fisher syndrome (MFS) is a variant of Guillain-Barre syndrome characterized by the triad of ophthalmoplegia, ataxia and areflexia. Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's

accurate anatomic lesion sites and pathogeneiss is still unknown.

Unlike GBS, MFS causes descending paralysis, i.e. paralysis that begins in the upper body and gradually spreads downward. The difference between MFS and GBS is that different nerve groups are affected such that paralysis in GBS tends to start in the legs and move up, where in MFS it starts in the head, affecting eye muscles, balance and slowly descends to the neck arms etc. MFS does not generally have the life threatening aspects of GBS but can be very difficult to live through with double vision, nausea, weakness, difficulty.

Like Guillain-Barré syndrome, symptoms may be preceded by a viral illness. Additional symptoms include generalized muscle weakness and respiratory failure. The majority of individuals with Miller Fisher syndrome have a unique antibody that characterizes the disorder. A spinal tap reveals the presence of elevated protein levels. The patient experiences the classical triad of ataxia, opthalmoplegia and areflexia: loss of tendon reflexes and coordination, difficulty walking and standing, vision problems. Also tingling, numbness, dizziness, nausea. Anti-GQ1b antibodies are produced.

Treatment for Miller Fisher syndrome is identical to treatment for Guillain-Barré syndrome: intravenous immunoglobulin (IVIg) or plasmapheresis (a procedure in which antibodies are removed from the blood) and supportive care.
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I said this to Alan (and correct me if I'm wrong). "Alan, this says it's descending paralysis (neck down), you never had that. You have only the feet, burning between certain toes). And since the treatment is exactly the same....IVIG. it doesn't really matter...


But since many of you might have these symtpoms and maybe you have never heard of Miller Fisher, I thought I might share this info with you.


Haven't watched this episode of HOUSE yet.

Melody