Honorary Board Executive Director

1 Miller FisherSyndromeTo obtain more information, contact theGBS/CIDP Foundation International The Holly Building104 1/2 Forrest Avenue Narberth PA 190721-866-224-3301 (610) 667-0131 Fax: (610) email: BoardRachel Chagall*Marjorie H. Downey*Andy Griffith*Joseph Heller*# Executive DirectorEstelle L. BensonOfficersSara Voorhees Pessel,* PresidentJoel S. Steinberg, MD, PhD,* Vice PresidentSue D. Baier,* SecretaryHenry Friedman,* TreasurerJerry R. Jones, TreasurerBoard of DirectorsRobert Benson, CLU, ChFC* Patricia H. Blomkwist-Markens*Patricia Bryant* Thomas S. ButlerElizabeth B. Emerson Thelma Gifford, RN*Susan Keast* Philip H.

2 KinnicuttKim Koehlinger* Harriette LionGlennys Sanders* Laura E. Stegossl, Advisory BoardBarry G. W. Arnason, MDArthur K. Asbury, MDRichard J. Barohn, MDMark J. Brown, MDKopel Burk, MD*David Cornblath, MDMarinos C. Dalakas, MDJonathan Goldstein, MDKenneth C. Gorson, MDMichael G. Graves, MDJohn W. Griffin, MDAngellka F. Hahn, MDHans-Peter Hartung, MDThomas L. Hedge, Jr., MD*Prof. HughesJonathan S. Katz, MDCarol Lee Koski, MDRichard A. Lewis, MDRobert Lisak, MDRobert G. Miller, MDGareth J. Parry, MDAllan H. Ropper, MDJohn T. Sladky, MDJoel S. Steinberg, MD, PhD*Pieter A. van Doorn, MDProf. Hugh J. Willison, PhD*Former GBS or CIDP patients#DeceasedInternational OfficeThe Holly Building104 1/2 Forrest AvenueNarberth PA 19072 Supported by an educational grant from Talecris Biotherapeutics, Center for Science and Fisher syndrome (MFS), also called Fisher ssyndrome, usually beginswith the rapid development,over days, of 3 problems: 1)weak eye muscles, withdouble or blurred vision, and often droopingeyelids with facial weakness; 2) poor balanceand coordination with sloppy or clumsy walking.

3 And 3) on physical examination, loss of deeptendon reflexes, such as the knee and ankle is named after Dr. C. Miller Fisherwho described it in 1956 as a limited variantof ascending paralysis, Guillain-Barr syndrome (GBS).Patients typically seekmedical attention becauseof a rapid decrease invision over days and/ordifficulty walking. Thesechanges are frequently preceded by a viral ordiarrheal illness 1 to 4 weeks earlier. Slurredspeech, difficulty swallowing and abnormalfacial expression with inability to smile or whistlemay also occur. Examination shows poorbalance and coordination of the hands as wellas loss of deep tendon reflexes and eye muscleweakness.

4 Facial weakness, enlarged or dilatedpupils and a decreased gag reflex onstimulation of the throat can be present in somepatients. Tests of nerve conduction may showdiminished activity of nerves that carry sensoryinformation to the spinal cord and resonance (MRI) or other imagingof the brain and/or spinal cord are usuallynormal. Spinal fluid protein is often Fisher syndrome is uncommon, withmany patients going on to develop theprominent widespread weakness of , this disorder isoften short lived, progressingfor only a few weeks and thenimproving. MFS symptoms cansignal the beginning of GBS,with breathing difficulties, so patients are oftenhospitalized for observation.

5 In pure MFS, anear full recovery typically occurs within 2-3months. In rare cases when symptomssubstantially impair function, various treatmentsthat limit or neutralize immune system activitymay be considered. These include high doseimmune globulins or plasma cause(s) of Fisher ssyndrome is not completelyunderstood. The waddling,duck-like gait is likely due to the loss of a fat richinsulating material calledmyelin around nerves,designated as 1A, that innervate the majorsensory organ of muscle called the musclespindle. These fibers send information to thespinal cord about the speed and extent ofmuscle stretch without which skeletal musclescan not properly function.

6 As the clinical courseprogresses, other sensory fibers can be involvedas well as motor and autonomic fibers thatrespectively innervate muscles that move theeyes and face and control function of the eye,pupil and the bladder. Multiple lines of evidencesupport an auto-immune mechanism in whichthe preceding/triggering infection stimulatesproduction of an antibody that reacts to asugar found on both the surface of infectiousorganism and the peripheral nerve causingdemyelination and loss of function of the Foundationwas founded in 1980by Robert and EstelleBenson to helpothers with this familyof frightening and potentially catastrophicdisorders.

7 The Foundation has over 160chapters around the world. Its goals are tosupport you, the patient and family. Ourmedical advisory Board includes some of theworld s leading experts and some whothemselves have had GBS and Fisher patients and lovedones are invited to contact theFoundation for assistance andinformation. There is a special subgroup forMiller Fisher patients. Sign-up at the nationaloffice to be included in the group. A list isprovided with permission to insure privacy. Wecan often direct you to local physicians who arefamiliar with the GBS family of with local support group chapters isencouraged.

8 Health care professionals cancontact us for literature and to supply emotionalsupport for patients. We are here to serve Is MillerFisherSyndrome?How Is MFSyndromeDiagnosed?How is MFST reated?WhatCausesFisherSyndrome?The GBS/CIDPF oundationInternationalNeed Help?To obtain more information, write to theGBS/CIDP Foundation International The Holly Building 104 1/2 Forrest Avenue, Narberth PA 19072or call 1-886-224-3301 (610) 667-0131 Fax (610) 667-7036 email: tax deductible contribution to help us help others will be most gratefully appreciated. Non-profit 501(c)(3).Miller Fisher syndrome (MFS), also called Fisher ssyndrome, usually beginswith the rapid development,over days, of 3 problems: 1)weak eye muscles, withdouble or blurred vision, and often droopingeyelids with facial weakness; 2) poor balanceand coordination with sloppy or clumsy walking;and 3) on physical examination, loss of deeptendon reflexes, such as the knee and ankle is named after Dr.

9 C. Miller Fisherwho described it in 1956 as a limited variantof ascending paralysis, Guillain-Barr syndrome (GBS).Patients typically seekmedical attention becauseof a rapid decrease invision over days and/ordifficulty walking. Thesechanges are frequently preceded by a viral ordiarrheal illness 1 to 4 weeks earlier. Slurredspeech, difficulty swallowing and abnormalfacial expression with inability to smile or whistlemay also occur. Examination shows poorbalance and coordination of the hands as wellas loss of deep tendon reflexes and eye muscleweakness. Facial weakness, enlarged or dilatedpupils and a decreased gag reflex onstimulation of the throat can be present in somepatients.

10 Tests of nerve conduction may showdiminished activity of nerves that carry sensoryinformation to the spinal cord and resonance (MRI) or other imagingof the brain and/or spinal cord are usuallynormal. Spinal fluid protein is often Fisher syndrome is uncommon, withmany patients going on to develop theprominent widespread weakness of , this disorder isoften short lived, progressingfor only a few weeks and thenimproving. MFS symptoms cansignal the beginning of GBS,with breathing difficulties, so patients are oftenhospitalized for observation. In pure MFS, anear full recovery typically occurs within 2-3months.