RECURRENT MILLER-FISHER-SYNDROME WITH ANT I-GQ1B ANTIBODY

Introduction. - Miller-Fisher syndrome is defined by the triad: ophtha lmoplegia, ataxia and areflexia. This rare entity is generally regarde d as a variant of the Guillain-Barre syndrome, although neurophysiolog ical patterns differ. In the acute phase of the disease, sera of affec ted patients contain high titers of antigangliosid anti-Gg1b, which is a specific marker. Recurrences are exceptional. Exegese. - We report the case of a man with three recurrences of Miller-Fisher syndrome wit hin 16 years. Anti-GQ1b antibody titers were elevated during an episod , decreasing but nor completely and vanishing 2 years later. Intraveno us human immunoglobulin treatment probably accelerated improvement at the two last episods. Conclusions. - Some experimental and immunohisto chemical data from the literature argue for a probable direct pathogen ic role of antibodies against GQ1b gangliosid in this syndrome. This s hould be a rationale for the use of immunomodulating treatments. (C) 1 998, Elsevier, Paris.