Miller Fisher syndrome: A comprehensive review and clinical insights

Abstract

Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome (GBS), characterized by the clinical triad of ophthalmoplegia, ataxia and areflexia. Anti-ganglioside GQ1b antibodies, detected in 80–90% of cases, play a central role in molecular mimicry-driven pathogenesis. While albuminocytological dissociation in cerebrospinal fluid (CSF) and electrophysiological findings (e.g., sensory axonal neuropathy, absent H-reflex) aid diagnosis, overlap syndromes with GBS or Bickerstaff brainstem encephalitis (BBE) necessitate early recognition to guide management. This review summarize current evidence on MFS pathogenesis, diagnostic challenges, and treatment paradigms, while proposing novel hypotheses on genetic predispositions and calcium-dependent antibody mechanisms.