Miller-Fisher syndrome is an insidious infectious disease that disrupts movement on the one hand and can also impair the speech center on the other. The nerves and nerve roots are destroyed by inflammation as part of Miller-Fisher syndrome; many of those affected are therefore also dependent on a wheelchair.
What is Miller Fisher Syndrome?
The doctor calls Miller-Fisher syndrome a rare disease that mainly affects the peripheral nervous system. The syndrome usually 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. The therapy depends on the course of the disease; Symptoms often disappear 14 days after Miller-Fisher syndrome, but it can sometimes happen that a rehabilitation period is necessary to get rid of all limitations. See AbbreviationFinder for abbreviations related to Miller Fisher Syndrome.
So far, doctors are faced with an unexplained mystery as to why Miller-Fisher syndrome can occur. However, experts assume that Miller-Fisher syndrome is an autoimmune disease that can occur after a viral infection. The reasons why and why are not known.
Symptoms, Ailments & Signs
While Guillain-Barré syndrome paralyzes the entire body musculature, Miller-Fisher syndrome initially manifests itself with eye movement disorders. Sometimes, however, a loss of reflexes in the muscles (areflexia) can also be detected. The patient complains of double vision because of the disturbances, which mainly affect the eye movements.
The affected person cannot control eye movement, nor can impulses that flow from the brainstem via the nerves directly into the eye muscles be transmitted. Even if the loss of muscle reflexes is noticed, there is no typical impairment that restricts the patient or leads to the occurrence of a disease value.
The affected person subsequently complains about disturbances in the target movements of his legs and arms or the trunk, so that balance disorders can sometimes occur. According to statistics, every sixth patient suffers from bladder dysfunction. The severity of the disturbances in the target movements plays an important role in the context of therapy.
Diagnosis & disease progression
If eye muscle disorders occur, the doctor must also take any other diseases of the brainstem into account. In addition to Miller Fisher syndrome, strokes, botulism or circulatory disorders are also possible. For this reason, the attending physician initially concentrates on the layered examination of the brainstem. He uses a computer tomogram ( CT ) or a magnetic resonance imaging (MRI).
Any ultrasound examinations of the arteries that supply the brain can also provide information as to whether Miller-Fisher syndrome is present. The functions of the brainstem are then examined by means of neurophysiological examinations. The special nerve tracts can be checked for their potential. The doctor then examines the cerebrospinal fluid ( liquor cerebrospinalis ).
That shows an enormous increase in protein content, but only a slight increase in detectable cells, so that one must speak of cytoalbuminic dissociation. Special antibodies can also be detected in the blood. Antibodies against the so-called GQ1b ganglioside can be detected in Miller-Fisher syndrome.
A forecast cannot be made; the course of the disease can be so different that all symptoms have disappeared after just 14 days, but the problem can also arise that permanent damage actually remains. However, the patient must be aware that, as a rule, he has to undergo a long period of rehabilitation so that all the disorders that have occurred as part of the Miller-Fisher syndrome can be eliminated again.
Miller-Fischer syndrome causes paralysis in different parts of the body. In most cases, the eyes are primarily affected, so that those affected can no longer move them. There are also other visual problems, double vision and so-called blurred vision. The patient’s quality of life is significantly reduced and limited by the Miller-Fischer syndrome.
The legs can usually no longer be moved or only to a very limited extent, resulting in restricted movement and other limitations in everyday life. Balance and coordination disorders also occur, so that those affected are often dependent on the help of other people in their everyday lives. It can also lead to a stroke or other circulatory disorders.
It is not uncommon for the symptoms of Miller-Fischer syndrome to appear permanently and not disappear again. These symptoms can usually not be removed even with treatment. The treatment itself can only be carried out to a very limited extent and depends on various therapies. Psychological treatments are also often necessary to prevent or treat depression and other upset moods. It cannot generally be predicted whether Miller-Fischer syndrome will lead to a reduction in life expectancy.
When should you go to the doctor?
A general malaise, a feeling of illness and a decrease in inner strength indicate a health imbalance. If the symptoms persist or if further disorders occur, a doctor should be consulted. Abnormalities in eye movements or peculiarities of vision must be examined and treated. In many cases, there is a perception of double vision or reduced vision. Muscle reflex loss is alarming and should be reported to a doctor immediately. If the eye movements can no longer be regulated voluntarily or if there is a loss of self-reflexes, a doctor must be consulted. Irregularities in general movements are also a cause for concern and should be clarified by a doctor.
If the affected person has no control over the voluntary movement of arms and legs, he needs medical help. If locomotion is difficult or there are motor disorders, a doctor should be consulted. If the general risk of accidents and injuries increases due to the discrepancies in the movement sequences, a doctor should be consulted. If everyday obligations can no longer be fulfilled as usual, if the quality of life is reduced or if well-being decreases, a doctor should be consulted. Unsteady gait and balance disorders are further indications of a health impairment. Behavioral problems, mood changes and withdrawal behavior should also be discussed with a doctor.
Treatment & Therapy
The treatment of Miller-Fisher syndrome also depends on the course of the disease. In severe cases, the doctor treats the patient with immunoglobulins or plasmapheresis. A type of blood washing is called plasmapheresis treatment; the immunoglobulins and also those antibodies which are responsible for the Miller-Fisher syndrome are washed out of the blood.
As a rule, the person concerned receives two to four treatments; after that, the blood should be clear of antibodies. After the causal treatment comes the therapy; If the patient has difficulties with his movements, they must be treated and trained in such a way that an independent life is possible again and sometimes any aids – such as the wheelchair – can be dispensed with in the long term.
Therapy is effective when there is a team of doctors, occupational therapists, speech therapists, physiotherapists, psychologists and social workers to look after the patient. Because after Miller-Fisher syndrome, rehabilitation is often necessary, with the focus on ataxia – the disruption of target movements. By means of physiotherapy, the patient learns that he can carry out his movements precisely again.
In the course of physiotherapy, the patient learns how to eliminate any disturbances when walking or standing. Occupational therapy, on the other hand, mainly deals with fine motor disorders. It is important that there is precise coordination between the groups as part of the therapies. The physiotherapists should very well be informed of which units have been carried out by the occupational therapist.
The occupational therapist primarily ensures that the patient – after very difficult cases – manages to wash, eat and dress independently again and is supported in their everyday situations. At the end of the rehabilitation, the patient should no longer have any permanent damage. Depending on the clinical picture, other therapeutic measures can also be taken.
Outlook & Forecast
The prognosis for Miller-Fisher syndrome is usually very good if the cause is known and can be cured. Since it is mostly a result of an infection, eliminating the infection will also result in a gradual recovery of the nerves. The failed or restricted bodily functions can return within a few months, with no further damage or other consequences to be expected.
In some cases, however, motor disorders persist. These can be countered with physiotherapy or occupational therapy, which has a very high chance of success. Miller-Fisher syndrome is very rarely associated with nerve damage that is completely irreparable.
As with all syndromes or diseases that affect nerve function, early diagnosis is important. This leads to early treatment. If the symptoms are not recognized correctly or classified incorrectly, the prognosis can deteriorate badly due to incorrect treatment. In a few cases, Miller-Fisher syndrome can also affect breathing, making the patient’s prognosis very poor. However, other diseases of the nerves are often involved in such cases.
Since no cause is known to date, which factors promote Miller-Fisher syndrome, no preventive measures can be recommended. Miller-Fisher syndrome can therefore not be prevented.
Miller-Fisher syndrome can lead to various complications that can have a very negative impact on the sufferer’s quality of life. In general, a doctor should therefore be consulted at an early stage in order to prevent further deterioration of the symptoms. Most of those affected suffer from eye movement disorders as a result of this syndrome.
There is usually uncontrolled movement and often a loss of control over the eye muscles. The syndrome often leads to developmental disorders in children, so that they can also develop depression or other mental disorders. Especially in childhood, bullying is not uncommon due to Miller-Fisher syndrome.
Balance disorders sometimes occur, with most patients not being able to control their bladder properly. The legs cannot be moved in a targeted manner either, which can lead to 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 person affected. The further course depends very much on the cause of the disease, so that a general prediction is not possible.
You can do that yourself
Miller-Fisher syndrome always requires medical diagnosis and treatment. 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 the therapy, as these substances can cause problems with blood washing. The doctor will tell the patient what to eat before the Plasmaphere treatment, thus enabling a symptom-free therapy. After treatment, comprehensive follow-up care is required. In addition, the patient must regularly carry out physiotherapy exercises in order to improve the movement sequences and to eliminate any disturbances when standing or walking. As part of occupational therapymainly fine motor disorders are treated. The patient can support these measures at home by doing exercises recommended by the doctor or therapist.
In severe cases, the affected person must also relearn normal processes and activities such as washing or dressing. Here, above all, the relatives are in demand, who have to stand by as supportive help. It may be necessary to organize aids such as crutches or a wheelchair as well as facilities for the disabled.