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Grebenciucova et al. Neuroimmunol Neuroinflammation 2017;4:93-5 Neuroimmunology and
DOI: 10.20517/2347-8659.2016.48
Neuroinflammation

www.nnjournal.net
Case Report Open Access

Miller-Fischer syndrome after etanercept

Elena Grebenciucova , John H. Pula 2
1
1 Department of Neurology, University of Pennsylvania, Philadelphia, PA 19019, USA.
2 Department of Neurology, HealthSystem, NorthShore University, Evanston, IL 60069, USA.
Correspondence to: Dr. Elena Grebenciucova, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19019, USA.
E-mail: Elena.grebenciucova@uphs.upenn.edu
How to cite this article: Grebenciucova E, Pula JH. Miller-Fischer syndrome after etanercept. Neuroimmunol Neuroinflammation 2017;4:93-5.

Dr. Elena Grebenciucova is currently a multiple sclerosis fellow at the University of Pennsylvania. Her interests
lie in the field of neuroimmunology and neuro-infectious disorders, and her research interests include learning
why some patients on anti-tumor necrosis factor alfa agents develop demyelinating events, while others do not.

ABSTRACT
Article history: The authors describe a case of Miller-Fischer syndrome, a rare demyelinating syndrome,
Received: 22-11-2016 preceded by a viral prodrome and three doses of etanercept, an anti-tumor necrosis
Accepted: 24-04-2017 factor α (anti-TNFα) agent. Anti-TNFα agents are associated with an induction of episodes
Published: 23-05-2017 of demyelination and may unmask multiple sclerosis in those who are immunogenetically
predisposed.
Key words:
Miller-Fischer syndrome,
demyelination,
anti-TNFα agent,
etanercept

INTRODUCTION against the ganglioside Q1b (GQ1b) is 90% specific
and 85-90% sensitive. Cases of demyelination,
[2]
Miller-Fischer syndrome (MFS) is a rare self- both central and peripheral, have been described in
limiting demyelinating disorder that is considered patients treated with anti-tumor necrosis factor α (anti-
to be a variant of Guillain-Barre syndrome (GBS).
MFS typically affects cranial nerves first and then TNFα) agents. This case describes a patient with MFS
descends, classically resulting in a clinical triad of preceded by both a viral illness and the use of the anti-
ophthalmoplegia, areflexia, and ataxia. An antibody TNFα agent etanercept.
[1]

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