J Clin Neurol.  2019 Jul;15(3):308-312. 10.3988/jcn.2019.15.3.308.

Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome

Affiliations
  • 1Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea.
  • 2Department of Neurology, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
  • 3Department of Neurology, Dong-A University College of Medicine, Busan, Korea. advania9@chol.com
  • 4Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea.
  • 5Department of Molecular Neuroscience, Dong-A University College of Medicine, Busan, Korea.
  • 6Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. jsb_res@hotmail.co.kr

Abstract

BACKGROUND
AND PURPOSE: The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients.
METHODS
We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO).
RESULTS
Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days.
CONCLUSIONS
The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.

Keyword

ophthalmoplegia; miller fisher syndrome; guillain-barré syndrome; GQ1b ganglioside
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