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- Title
Miller Fisher Syndrome and Guillain Barré Syndrome: Rehabilitation of a Complex Patient Case.
- Authors
Mayer, J. E.; McNamara, C. A.; O'Brien, N.; Bello, J.; Ferrante, T.; LeClair, N.; Koval, M.; Kraus, B.; Mayer, J.
- Abstract
Background and Purpose: Guillain-Barre Syndrome (GBS) presents with acute peripheral neuropathy leading to a rapid progression of ascending motor and sensory deficits, with occasionally associated autonomic dysfunction, cranial nerve involvement and respiratory failure. Miller Fisher syndrome (MFS), a rare variant of GBS affecting one in 1 million people, is characterized by ophthalmoplegia, ataxia and areflexia. In unusual cases, MFS and GBS may overlap, indicated by paresis of the extremities or definite limb weakness and reported as 5%-28% of MFS diagnosed cases. This case report describes the physical therapy examination, a novel treatment intervention, and outcomes for a patient with a complex diagnosis of overlapping MFS-GBS. Case Description: The patient, a 57-year-old male physician, was diagnosed with complex regional pain syndrome (CRPS) following a quadriceps muscle tear. Over the course of one month, the patient experienced evolving motor, sensory, autonomic and cranial nerve dysfunction including diplopia, ataxia, areflexia, weakness, multiple falls and respiratory distress. He was diagnosed with MFS-GBS. Further complications included repeated traumatic brain injury secondary to falls. Following acute care and short inpatient rehabilitation stay, inadequate medical coverage delayed further treatment by 3-months, despite persistent impairments and functional limitations. At five months post-onset of symptoms, a 7-week treatment program was initiated consisting of four 60-minute intensive sessions per week, 2 aquatic and 2 land based. Outcomes: Pre-intervention functional mobility, endurance, gait velocity, balance and quality of life were measured using the Timed Up and Go (TUG), 6 minute walk test (6MWT), 10 meter walk test (10MWT), Berg Balance Scale (BBS), and Short form-36 (SF-36), respectively. Following completion of the 7-week therapeutic program, improvements were demonstrated on the 6MWT (47.9m change), TUG (26.8sec change), 10MWT (fast velocity .21 m/s change) and SF-36 (all sub-scales excluding general health). BBS scores did not change. Short term goals were achieved, however long term goals were not. Initiation of treatment was attempted again 6 weeks later, but was discontinued due to a relapse. Discussion: This case serves as a means for clinicians to better identify signs and symptoms that may present in patients along the GBS continuum. The preceding medical complication leading up to the diagnosis of MFS-GBS was CRPS, an atypical prior event. The novel treatment approach including aquatic and land-based therapy demonstrated favorable short term outcomes. Although most cases of GBS and MFS have a good prognosis and relapse is rare, symptom recurrence is possible and complex patients may require longer recovery time with continued rehabilitation.
- Subjects
AQUATIC exercises; POSTURAL balance; EXERCISE physiology; LIFE skills; PHYSICAL therapy; GUILLAIN-Barre syndrome; WALKING; MILLER Fisher syndrome; MIDDLE age
- Publication
Journal of Aquatic Physical Therapy, 2017, Vol 25, Issue 2, p66
- ISSN
2377-6102
- Publication type
Article