This handout is for miller-fisher syndrome (gbs variant). Your care team identified this based on: classic mfs triad: ophthalmoplegia + ataxia + areflexia (van doorn 2011 pmid 25023340).
Other reasons your team may use this plan: anti-gq1b antibodies positive — ~85% of mfs (highly specific) (wakerley 2016 pmid 25072194); bickerstaff brainstem encephalitis overlap — mfs triad + encephalopathy + brainstem signs; same anti-gq1b+ spectrum (wakerley 2016); pcb variant overlap — bulbar + neck + upper-limb weakness with sparing of legs (wakerley 2016).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ivig | 0.4 g/kg/d × 5 d (total 2 g/kg) | IV | daily × 5 d | EAN/PNS 2023 — IVIG preferred for MFS (Cochrane MFS subgroup PMID 25238327); check IgA pre-IVIG |
| plasmapheresis (PLEX) | 5 sessions over 7-10 d (q48h) | IV | 5 sessions q48h | Raphael Cochrane PMID 22786475 — alternative; less evidence specifically in pure MFS (EAN/PNS 2023) |
Plan: MFS — IVIG preferred (per Cochrane subgroup); supportive + overlap-variant monitoring (Hughes Cochrane 2014 PMID 25238327; EAN/PNS 2023)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Neuro-ophthalmology follow-up for ophthalmoplegia resolution; gait/balance therapy; usually monophasic full recovery in 2-6 mo (van Doorn 2011)
Guideline: 2023 EAN/PNS GBS Guideline + Hughes Cochrane 2014 + Wakerley 2016 anti-GQ1b syndromes spectrum