Dagklis Ioannis E, Papagiannopoulos Sotirios, Theodoridou Varvara, Kazis Dimitrios, Argyropoulou Ourania, Bostantjopoulou Sevasti
3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece.
Case Rep Neurol Med. 2016;2016:3431849. doi: 10.1155/2016/3431849. Epub 2016 Apr 30.
Miller-Fisher syndrome (MFS) is considered as a variant of the Guillain-Barre syndrome (GBS) and its characteristic clinical features are ophthalmoplegia, ataxia, and areflexia. Typically, it is associated with anti-GQ1b antibodies; however, a significant percentage (>10%) of these patients are seronegative. Here, we report a 67-year-old female patient who presented with the typical clinical features of MFS. Workup revealed antibodies against glutamic acid decarboxylase (GAD) in relatively high titers while GQ1b antibodies were negative. Neurological improvement was observed after intravenous gamma globulin and follow-up examinations showed a continuous clinical amelioration with simultaneous decline of anti-GAD levels which finally returned to normal values. This case indicates that anti-GAD antibodies may be associated with a broader clinical spectrum and future studies in GQ1b-seronegative patients could determine ultimately their clinical and pathogenetic significance in this syndrome.
米勒-费希尔综合征（MFS）被认为是吉兰-巴雷综合征（GBS）的一种变异型，其特征性临床症状为眼肌麻痹、共济失调和腱反射消失。通常，它与抗GQ1b抗体相关；然而，这些患者中有相当比例（>10%）为血清学阴性。在此，我们报告一名67岁女性患者，她表现出MFS的典型临床症状。检查发现其谷氨酸脱羧酶（GAD）抗体滴度相对较高，而GQ1b抗体为阴性。静脉注射丙种球蛋白后观察到神经功能改善，随访检查显示临床持续改善，同时抗GAD水平下降，最终恢复到正常水平。该病例表明抗GAD抗体可能与更广泛的临床谱相关，对GQ1b血清学阴性患者的进一步研究最终可能确定它们在该综合征中的临床和发病机制意义。
