search for


Clinical Characteristics of Miller-Fisher Syndrome and Bickerstaff Brainstem Encephalitis
Ann Optom Contact Lens 2020;19:103-109
Published online December 25, 2020
© 2020 The Korean Optometry & Contact Lens Study Society

Min Ha Kim, MD1 , Yuri Seo, MD2,3, Sueng-Han Han, MD3 , Jinu Han, MD1

Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine1, Seoul, Korea
Institute of Vision Research, Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine2, Yongin, Korea
Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine3, Seoul, Korea
Correspondence to: Jinu Han, MD
Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
Tel: 82-2-2019-3445, Fax: 82-2-3463-1049
Received September 17, 2020; Revised November 11, 2020; Accepted December 7, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: To investigate the clinical characteristics of patients clinically diagnosed with anti-GQ1b antibody syndrome.
Methods: From November 2005 to July 2019, we retrospectively reviewed the medical records of 52 patients diagnosed with Miller-Fisher syndrome, Bickerstaff brainstem encephalitis or anti-GQ1b antibody syndrome. Symptom including acute ophthalmoplegia, ataxia, hyporeflexia and other neurologic features were reviewed. Laboratory results including cerebrospinal fluid (CSF) analysis and anti-ganglioside antibodies were also analyzed.
Results: Among 52 patients, 40 were diagnosed with classic Miller-Fisher syndrome, 3 patients were Guillain-Barré syndrome with ophthalmoparesis, 1 patient was acute ophthalmoparesis without ataxia, 2 patients were acute ataxic neuropathy, and 6 patients were diagnosis with Bickerstaff brainstem encephalitis. Thirty five patients were male (67.3%), the mean age of onset was 39.3 ± 16.7 years, and average follow-up duration was 9.6 ± 15.9 months. Forty-four patients (84.6%) showed preceding infection, and upper respiratory infection was more common than gastrointestinal infection. Forty-nine patients (94.2%) showed ophthalmoplegia, 48 patients (92.3%) showed ataxia and hyporeflexia was presented in 43/51 patients (84.3%). Other than classic symptoms, dysarthria (21/52, 40.4%), dizziness (27/52, 51.9%), and paresthesia (23/52, 44.2%) was observed. Among 48 patients who underwent CSF analysis, 11 patients (22.9%) showed albumino-cytologic dissociation. Only 12 patients (23.1%) had positive anti-ganglioside antibodies.
Conclusions: Anti-GQ1b antibody syndrome is not easy to differentiate from other diseases, careful physical examination and history taking is necessary to make correct diagnosis. The recognition of accompanying symptoms and signs could facilitate early and exact diagnosis of anti-GQ1b antibody syndrome.
Keywords : Ataxia; Encephalitis; GQ1b ganglioside; Miller-Fisher syndrome; Ophthalmoparesis

December 2020, 19 (4)