Miller-Fisher Syndrome

Under the Miller-Fisher Syndrome an insidious infectious disease is described, which on the one hand disrupts the sequence of movements and on the other hand can also affect the language center. The nerves and nerve roots are destroyed by inflammation in the Miller-Fisher syndrome; many of those affected are therefore dependent on a wheelchair.

What is Miller-Fisher Syndrome?

The affected person can neither control the eye movement, nor can impulses that flow from the brain stem via the nerves directly into the eye muscles can be passed on.
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The medic referred to as Miller-Fisher Syndrome a rare disease that predominantly affects the peripheral nervous system. As a rule, the syndrome attacks the patient's cranial nerves. The disease was named after Charles Miller Fisher, a Canadian neurologist.

It should be noted that the Miller-Fisher syndrome is a variant of the so-called Guillain-Barré syndrome. The therapy is based on the course of the disease; Often there are no more symptoms 14 days after Miller-Fisher syndrome, but it may happen that a rehabilitation period is necessary to get rid of all restrictions.

causes

So far, doctors have been faced with an unresolved 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 the Guillain-Barré syndrome paralyzes the entire body muscles, the Miller-Fisher syndrome manifests itself in the beginning with eye movement disorders. Occasionally, however, a loss of reflexes in the muscles (areflexia) can also be detected. Due to the disturbances, which mainly affect the eye movements, the patient complains of double vision.

The person affected can neither control the eye movement nor can impulses that flow from the brain stem via the nerves directly into the eye muscles can be passed on. Even if the loss of the muscular reflexes is noticed, there is no typical impairment that restricts the patient or leads to a disease value.

The affected person then complains of disturbances in the target movements of his legs and arms or the trunk, so that disturbances of balance can sometimes occur. According to statistics, every sixth patient suffers from bladder dysfunction. The severity of the target movement disorders plays an important role in therapy.

Diagnosis & course of disease

If eye muscle disorders occur, the doctor must also take any other diseases of the brain stem into account. In addition to Miller-Fisher syndrome, strokes, botulism or circulatory disorders are also possible. For this reason, the attending physician concentrates on the layer examination of the brain stem at the beginning. He uses a computed tomogram (CT) or magnetic resonance tomogram (MRI).

Any ultrasound examinations of the arteries that supply the brain can also provide information on whether Miller-Fisher syndrome is present. The functions of the brain stem are then examined using neurophysiological examinations. The special nerve tracts can be checked for their potential. The doctor then examines the nerve fluid (cerebrospinal fluid).

That shows an enormous increase in the protein content, but only a slight increase in the detectable cells, so that one has to speak of a 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 after 14 days all symptoms have disappeared, but the problem can also arise that permanent damage actually remains. However, the patient must be aware that he usually has to take long rehabilitation so that all disorders that have arisen in the context of Miller-Fisher syndrome can be resolved again.

Complications

Miller-Fischer syndrome causes paralysis in different regions 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 veiled vision. The patient's quality of life is significantly reduced and restricted by the Miller-Fischer syndrome.

The legs can usually no longer be moved or can only be moved to a very limited extent, resulting in movement restrictions and other restrictions in everyday life. Furthermore, disturbances of balance and coordination occur, so that those affected are often dependent on the help of other people in their everyday life. It can also lead to a stroke or other disorders of the blood circulation.

It is not uncommon for the symptoms of Miller-Fischer syndrome to be permanent and never go away. As a rule, these complaints cannot be removed by treatment. The treatment itself can only be carried out to a very limited extent and depends on various therapies.It is not uncommon for psychological treatments to be necessary to prevent or treat depression and other moods. Whether or not Miller-Fischer syndrome will lead to a reduction in life expectancy cannot generally be predicted.

When should you go to the doctor?

A general malaise, a feeling of illness and a decrease in internal strength indicate a health disagreement. If the symptoms persist or if further disturbances occur, a doctor should be consulted. Any abnormalities in eye movements or peculiarities of vision must be examined and treated. In many cases, double vision or decreased vision occurs. Loss of reflex muscles is alarming and should be presented to a doctor immediately. If the eye movements can no longer be voluntarily regulated or if there is a loss of self-reflexes, a doctor must be consulted. Irregularities in general movement sequences are also worrying and should be clarified by a doctor.

If the person concerned 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 inconsistencies in the movement sequences, a doctor should be consulted. If the daily obligations can no longer be fulfilled as usual, if the quality of life is reduced or if well-being falls, a doctor should be consulted. Uncertainty of gait and disturbances of the balance are further indications of a health impairment. Behavioral problems, changes in mood and withdrawal behavior should also be discussed with a doctor.

Therapy & Treatment

Therapy for Miller-Fisher syndrome also depends on the course of the disease. In severe cases, the doctor treats the patient with immunoglobulins or plasmapheresis. The plasmapheresis treatment is a type of blood wash; the immunoglobulins and also those antibodies that are responsible for Miller-Fisher syndrome are washed out of the blood.

As a rule, the person concerned receives two to four treatments; then the blood should be purified from the antibody. Therapy follows after the causal treatment; If the patient has difficulties with his movements, these have to be treated and trained in such a way that an independent life is possible again and sometimes 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 is found to care for the patient. After the Miller-Fisher syndrome, rehabilitation is often necessary, with the focus on ataxia - the disruption of target movements. Using physiotherapy, the patient learns that he can perform his movements precisely again.

As part of physiotherapy, the patient learns to correct 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 therapy. The physiotherapists should be informed which units were carried out by the occupational therapist.

The occupational therapist mainly ensures that the patient - after very severe cases - manages to wash, eat and get dressed again and is supported in his everyday situations. At the end of the rehabilitation the patient should have no more permanent damage. Depending on the clinical picture, further therapeutic measures can also be taken.

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Outlook & forecast

The prognosis for Miller-Fisher syndrome is usually very good if the cause is known and curable. Since it is mostly a consequence of an infection, clearing the infection will also lead to a gradual recovery of the nerves. The failed or restricted body 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 rarely associated with completely irreparable damaged nerves.

As with all syndromes or diseases that affect nerve functions, an early diagnosis is relevant. This leads to early treatment. If the symptoms are not correctly identified or classified incorrectly, the prognosis can worsen 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 also often involved in such cases.

prevention

Since no cause is known so far which factors favor the Miller-Fisher syndrome, no preventive measures can be recommended. Miller-Fisher syndrome cannot therefore be prevented.

Aftercare

Miller-Fisher syndrome can lead to various complications that can have a very negative effect on the quality of life of the person affected. In general, a doctor should therefore be consulted at an early stage in order to prevent further worsening of the symptoms. Most people affected by this syndrome suffer from eye movement disorders.

The result is mostly 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 psychological disorders. Miller-Fisher syndrome often leads to bullying, especially in childhood.

There are occasional imbalances in which most patients cannot 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 can 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.

As the most important measure, nicotine and alcohol should be avoided during and before therapy, as these substances can cause problems with blood washing. The doctor will tell the patient how to eat before the Plasmaphere treatment and thus enable symptom-free therapy. Comprehensive follow-up care is required after treatment. In addition, the patient must regularly perform physiotherapy exercises in order to improve the movement sequences and to eliminate any disturbances when standing or walking. In the context of occupational therapy, fine motor disorders are mainly treated. The patient can support these measures at home by performing exercises recommended by the doctor or therapist.

In severe cases, the person affected also has to relearn normal processes and activities such as washing or getting dressed. Here, the relatives are particularly 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.