Miller Fisher Syndrome Associated With Polymyoclonus

We described a 35-year-old man who presented with diplopia, dysarthria, loss of deep tendon reflexes, and rapidly progressive unsteadiness in standing and walking. Two days after admission, frequent, irregular, and shock-like movements appeared in the hands and abdomen. On laboratory examination, serum immunoglobulin G antibodies against GQ1b, GT1a and GD1b were all positive. Electrophysiologically, recording of the involuntary movements with surface electromyography showed irregular sharp discharges especially during weak muscle contraction. The clinical diagnosis of Miller Fisher syndrome associated with polymyoclonus was made, and all neurological symptoms including myoclonus improved after intravenous injection of immunoglobulin. The distribution of myoclonus and electrophysiological data suggested that the myoclonus, though different from propriospinal or spinal segmental myoclonus in the distribution and propagation, might still be of spinal cord origin.