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ISSN: 1734-1922
Archives of Medical Science
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vol. 16
Letter to the Editor

Clinical characteristics and outcomes of patients with overlapping Miller Fisher syndrome and myasthenia gravis

Jun-Liang Yuan
Yan Xing
Wen-Li Hu

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
Department of Neurology, Aviation General Hospital, China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Chaoyang District, Beijing, China
Arch Med Sci 2020; 16 (1): 233–236
Online publish date: 2019/12/31
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Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatigue, which is caused by autoantibodies directed against acetylcholine receptors (AChR) at the neuromuscular junction [1]. The prognosis is relatively favorable with optimum symptomatic, immunosuppressive and supportive treatment. Pyridostigmine is the preferred symptomatic treatment, and corticosteroids, azathioprine and thymectomy are first-line immunosuppressive therapies [2].
Guillain-Barré syndrome (GBS) is the most common and most severe acute paralytic neuropathy, with about 100,000 people developing the disorder every year worldwide [3]. Under the terms of GBS are several recognizable variants with distinct clinical and pathological features. As a rare variant of GBS, Miller Fisher syndrome (MFS) is an immune-mediated neuropathy that involves the triad of symptoms of acute ophthalmoplegia, ataxia and areflexia, also with positive GQ1b antibody. The current available treatments include intravenous immunoglobulin (IVIG), plasmapheresis, and supportive care including treatment of underlying infections and physical therapy [4]. MFS usually runs a benign clinical course, with case fatality of < 5% [5].
Up to now, the occurrence of MG and GBS overlapping in the same patient is quite scarce. To our best of knowledge, only four cases have previously been reported regarding the temporal coincidence between MG and MFS [6–9]. Here, we review all the above 4 cases, and we also describe a new case of our own. We also aimed to summarize the clinical characteristics and to elucidate the underlying mechanisms in such a rare overlapping syndrome.
Literature was reviewed through the databases of PubMed, Embase, Cochrane Library and Science Direct from January 1982 to June 2017, and the articles were restricted to those published in English. Key search terms included “Guillain-Barré syndrome”, “Miller Fisher syndrome” and “myasthenia gravis”. Patients with combined MG and MFS were identified and their clinical data such as gender, age, nationality, past history, precipitating factors, clinical presentations, laboratory examinations, cerebrospinal fluid (CSF) findings, AChR antibody, anti-GQ1b antibody, thymoma, treatment and prognosis during follow-up were all investigated in detail.
We herein present a case with a temporal coincidence between MG and MFS. A 72-year-old man first presented with acute bilateral ptosis, ophthalmoplegia,...

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