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Miller Fisher syndrome and plasmapheresis
Chiaki Kambara1, Hidenori Matsuo, Takayasu Fukudome
1Department of Neurology, Kawatana National Hospital, Nagasaki, Japan.
Abstract:
Treatment for Miller Fisher syndrome (MFS) is controversial, and even the natural history and prognosis are not fully understood. We retrospectively reviewed our cases of MFS for the last 3 years. The analysis of 4 MFS cases revealed that we had performed plasmapheresis or additional immunotherapy to each of 4 patients, and their symptoms resolved for up to 50 days after the onset (ataxia improved 20-35 days and ophthalmoplegia for 25-50 days) except for 1 patient, and that Guillain-Barré syndrome had been diagnosed in 1 patient who had developed profound muscle weakness. We also discovered that MFS patients had a deviated T-helper Type-1 (Th1)/T-helper Type-2 (Th2) polarization and that plasmapheresis can shift Th2-dominant status to Th1-dominant status in patients with MFS. Although plasmapheresis may remove humoral factors, including anti-GQ1b, and may induce a shift of the Th1/Th2 cytokine-producing cell balance in peripheral blood, the therapeutic rationale has not yet been established. Therefore, controlled clinical trials are required to show whether plasmapheresis leads to earlier recovery with fewer neurologic deficits in patients with MFS.
Insights
Miller Fisher syndrome (MFS) treatment remains unclear. Plasmapheresis or immunotherapy in four MFS patients showed symptom resolution, potentially by shifting T-helper cell balance, but further trials are needed.
Area of Science:
- Neurology
- Immunology
Background:
- Miller Fisher syndrome (MFS) treatment and prognosis are not well-established.
- The underlying pathophysiology, including T-helper cell polarization, requires further investigation.
Purpose of the Study:
- To retrospectively review MFS cases treated over three years.
- To analyze the efficacy of plasmapheresis and immunotherapy in MFS patients.
- To explore the impact of treatment on T-helper cell balance.
Main Methods:
- Retrospective analysis of four MFS cases.
- Review of treatments including plasmapheresis and immunotherapy.
- Assessment of symptom resolution timelines and T-helper Type-1 (Th1)/T-helper Type-2 (Th2) polarization.
Main Results:
- Symptom resolution (ataxia, ophthalmoplegia) observed in three of four patients within 50 days post-treatment.
- One patient was diagnosed with Guillain-Barré syndrome.
- MFS patients exhibited deviated Th1/Th2 polarization, which plasmapheresis appeared to shift from Th2-dominant to Th1-dominant status.
Conclusions:
- Plasmapheresis may influence humoral factors and shift Th1/Th2 balance in MFS.
- The therapeutic rationale for plasmapheresis in MFS requires further validation.
- Controlled clinical trials are necessary to confirm the benefits of plasmapheresis for MFS recovery and neurological outcomes.
