Anti-ganglioside complex antibody profiles in a recurrent complicated case of GQ1b-seronegative miller fisher syndrome and Bickerstaff brainstem encephalitis: a case report

Table 1 Reported cases describing the different phenotypes during various episodes

Case	Age	Sex	Episode	Preceding illness	DOC	Ophthalm oplegia	Ataxia	Areflexia	Hyper reflexia	PR	Limb weakness	GQ1b Ab	GSC Ab	Phenotype	FG at nadir	Treatment	Outcome	Reference
1	38	F	First	URI	–	+	+	+	–	–	–	+	n.e	MFS	1	IAPP	CR	[8]
1	38	F	Second	URI	–	–	–	+	–	–	+	+	n.e	GBS	4	IAPP	CR	[8]
2	10	F	First	URI	–	+	+	+	–	–	–	n.e	n.e	MFS	2	n.d	CR	[9]
	17		Second	n.d	–	–	+	+	–	–	–	n.e	n.e	Incomplete MFS	1	n.d	CR
	19		Third	Fever	+	+	+	+	–	+	±	+	n.e	BBE	5	IVIG	NCR
3	48	M	First	n.d	–	+	n.d	n.d	n.d	n.d	+	n.e	n.e	MFS-GBS	5	n.d	CR	[10]
3	53	M	Second	–	+	+	+	+	–	+	+	–	n.e	BBE-GBS	5	IVIG	CR	[10]
4	35	M	First	n.d	–	+	n.d	n.d	n.d	n.d	–	n.e	n.e	Incomplete MFS	1	–	CR	[11]
	38		Second	n.d	+	+	+	–	+	–	–	n.e	n.e	BBE	5	IVIG	CR
	43		Third	Fever	+	+	+	–	+	–	–	–	n.e	BBE	5	IVIG	CR
5	46	M	First	n.d	+	+	+	+	–	n.d	–	–	n.e	MFS (BBE)^a	3	IVIG	NCR	[12]
5	46	M	Second	n.d	+	+	+	+	–	+	±	–	n.e	BBE	2	IVIG	NCR	[12]
6	25	M	First	URI	–	+	+	+	–	–	+	–	+	MFS-GBS	4	IVIG	CR	Our case
	28		Second	URI	–	+	+	+	–	–	+	–	+	MFS-GBS	4	IVIG	CR
	33		Third	URI	+	+	+	+	–	+	+	–	+	BBE-GBS	5	IVIG	NCR

F female, M male, GBS guillain-Barré syndrome, MFS miller fisher syndromes, BBE bickerstaff brainstem encephalitis, Incomplete FS acute ophthalmoparesis, acute ataxic neuropathy, acute ptosis and acute mydriasis, URI upper respiratory infection, DOC disturbance of consciousness, PR pathological reflex, Limb weakness + MMT ≤ 3 at least one limb, Limb weakness ± MMT ≥ 4, MFS-GBS MFS with definite limb weakness (MMT ≤ 3), BBE-GBS BBE with definite limb weakness (MMT ≤ 3), n.e not examined, n.d not documented, FG fuctional grade, IAPP immunoadsorption plasmapheresis, IVIG intravenous immunoglobulin, CR complete recovery, NCR near complete recovery (Mild diplopia, weakness, and atxia without disability)
^aAlthough this case was considered “Fisher-Bickerstaff syndrome” and the first episode was considered MFS in reference [9], we consider the first episode as BBE because of the presence of drowsiness [1]

ISSN: 1471-2377