Miller Fisher Syndrome
What is Miller-Fisher syndrome?
The physician referred to as Miller-Fisher syndrome a rare disease that primarily affects the peripheral nervous system. As a rule, the syndrome attacks the cranial nerves of the patient. 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. Depending on the course of the disease, the therapy is oriented; Often, 14 days after the Miller-Fisher syndrome no more discomfort, but sometimes it may happen that a rehabilitation time is necessary to get rid of all restrictions.
So far, the physicians are facing an unresolved mystery why the Miller-Fisher syndrome can occur. Experts, however, believe that Miller-Fisher syndrome is an autoimmune disease that can occur after a viral infection. The reasons why and why are not known.
Symptoms, complaints & signs
While Guillain-Barré syndrome paralyzes the entire body musculature, Miller-Fisher syndrome is initially characterized by eye movement disorders. Sometimes, however, a reflex loss of the musculature (Areflexie) can be determined. Due to the disorders that mainly affect the eye movements, the patient complains about double images.
The affected person can neither control the eye movement, nor can impulses, which flow from the brainstem through the nerves directly into the eye muscles, be forwarded. Even if the loss of muscle reflexes is noticed, there is no typical impairment that limits the patient or results in the onset of a disease.
The person complains subsequently about disturbances of the target movements of his legs and arms or the trunk, so that sometimes balance disorders can occur. According to statistics, every sixth patient suffers from bladder dysfunction. The severity of target movement disorders plays an essential role in therapy.
Diagnosis & disease course
If eye muscle disorders occur, the physician must also take into account any other diseases of the brainstem. Thus, in addition to the Miller-Fisher syndrome strokes, botulism or circulatory disorders are possible. For this reason, the attending physician initially concentrates on the brainstem scan. He uses a computed tomogram (CT) or magnetic resonance imaging (MRI).
Any ultrasound examinations of the arteries supplying the brain may also provide an indication of whether Miller-Fisher syndrome is present. By means of neurophysiological examinations the functions of the brainstem will be investigated. The special nerve tracts can be checked for their potential. Subsequently, the physician examines the nerve water (cerebrospinal fluid).
This shows a tremendous increase in the protein content, but only a small increase in the detectable cells, so that it is necessary to speak of cytoalbuminic dissociation. Furthermore, special antibodies can also be detected in the blood. For example, antibodies to the so-called GQ1b ganglioside can be detected in the Miller-Fisher syndrome.
A forecast can not be created; the course of the disease can be so different that after 14 days all symptoms have disappeared, but the problem may arise that actually lasting damage remains. However, the patient should be aware that, as a rule, he will need to undergo a long period of rehabilitation so that all 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 not move them. It also leads to other vision problems, to double images and the so-called Schleiersehen. The patient's quality of life is significantly reduced and limited by Miller-Fischer syndrome.
Most of the time, the legs can not be moved, or they can only be moved very restrictedly, so that there are restrictions on movement and other restrictions in everyday life. Furthermore, disturbances of balance and coordination occur, so that the affected people are often dependent on the help of other people in their everyday lives. Furthermore, it can also lead to a stroke or other disorders of the blood circulation.
Not infrequently, the symptoms of Miller-Fischer syndrome occur permanently and do not disappear again. These complaints can not be removed by a treatment in the rule. The treatment itself can only be very limited and depends on different therapies. Not infrequently, psychological treatments are necessary to prevent or treat depression and other moods. Whether there is a reduction in life expectancy due to Miller-Fischer syndrome can not generally be predicted.
When should you go to the doctor?
A general malaise, a malaise and a decrease in internal forces indicate a health disagreement. If the symptoms persist or if there are other disorders, a doctor should be consulted. Abnormalities of eye movements or peculiarities of vision are to be examined and treated. In many cases, there is the perception of double vision or diminished vision. A reflex loss of the musculature is alarming and should be presented immediately to a doctor. If the eye movements can no longer be regulated voluntarily or if a loss of self-reflexes occurs, a doctor must be consulted. Irregularities of the general movement are also worrying and should be clarified by a doctor.
If the person has no control over the 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 accident and injury risk increases due to the inconsistencies of the movements, a doctor's visit should be made. If everyday obligations can no longer be met as usual, if the quality of life diminishes or well-being is reduced, a doctor should be consulted. Gait uncertainties and disorders of balance are further indications of a health impairment. Behavioral abnormalities, mood changes and withdrawal behavior should also be discussed with a doctor.
Therapy & Treatment
Following the course of the disease, the therapy of Miller-Fisher syndrome is also directed. In severe cases, the physician treats the patient with immunoglobulins or plasmapheresis. Under the plasmapheresis treatment is called a kind of blood washing; In doing so, 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 purified from the antibody. After the causal treatment the therapy follows; if the patient has difficulty with his movements, those 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 run.
Therapy is effective when there is a team of doctors, occupational therapists, speech therapists and physiotherapists, as well as psychologists and social workers who care for the patient. After the Miller-Fisher syndrome often rehabilitation is necessary, with the focus is on ataxia - the disorder of the target movements. By physiotherapy, the patient learns that he can perform his movements accurately again.
As part of physiotherapy, the patient learns again to correct any disturbances while walking or standing. Occupational therapy, on the other hand, is predominantly concerned with fine motor disorders. It is important that the therapies provide for close coordination between the groups. So the physiotherapists should be very well informed, which units were performed by the occupational therapist.
The occupational therapist primarily cares that the patient - after very severe cases - again the independent washing, eating and dressing creates and is supported in his everyday situations. At the end of rehabilitation, the patient should no longer show permanent damage. Depending on the clinical picture, other therapeutic measures may also be taken.
Outlook & Forecast
The prognosis for Miller-Fisher syndrome is usually very good if the cause is known and curable. Since it is mostly a result of an infection, eliminating the infection will also lead to a gradual recovery of the nerves. The failed or impaired body functions can return within a few months, with no further damage or other consequences to be expected.
In some cases, however, motor disturbances persist. These can be met with physiotherapy or occupational therapy, which has a very high chance of success. The Miller-Fisher syndrome is very rarely associated with completely irreparably damaged nerves.
Relevant, as with all syndromes or diseases that affect the nerve functions, an early diagnosis. This leads to an early treatment. If the symptomatology is not properly recognized or misclassified, the prognosis may deteriorate greatly due to incorrect treatment. In a few cases, Miller-Fisher Syndrome may also affect breathing, making the patient's prognosis very poor. However, in such cases often other diseases of the nerves are involved.
Since no cause is known yet which factors favor the Miller-Fisher syndrome, no preventive measures can be recommended. Therefore, the Miller-Fisher syndrome can not be prevented.
The Miller-Fisher syndrome can lead to various complications that can have a very negative impact on the quality of life of the person affected. In general, therefore, a doctor should be consulted at an early stage to prevent further worsening of the symptoms. Most people affected by this syndrome suffer from eye movement disorders.
It usually comes to an uncontrolled movement and often to a loss of control of the eye muscles. Frequently, the syndrome also leads to disorders of development in children, so that they can also fall ill with depression or other mental disorders. Especially in childhood, the Miller-Fisher syndrome is often bullying.
Sometimes there are disturbances of the balance, with most patients unable to control the bladder properly. The legs can also not be moved purposefully, so it can lead to restrictions in the 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
The Miller-Fisher syndrome always requires a medical diagnosis and treatment. Medical therapy can be supported by a number of self-help measures.
Nicotine and alcohol should be avoided as a major measure during and before therapy, as these substances may cause blood wash problems. The doctor will tell the patient how to feed themselves before the treatment with the plasma to enable symptom-free therapy. After treatment, comprehensive aftercare is required. In addition, the patient must regularly perform physiotherapy exercises to improve movement and correct any interference with standing or walking. Occupational therapy mainly deals with fine motor disorders. The patient may assist at home by performing exercises recommended by the physician or therapist.
In severe cases, the person concerned must also learn normal procedures and activities such as washing or dressing. Here, above all, the relatives are in demand, who must stand as supportive help. It may be necessary to organize aids such as crutches or a wheelchair as well as a disability-friendly facility.