title: Recurrent Miller Fisher syndrome in children.
abstract: BACKGROUND
  Miller Fisher syndrome is usually a monophasic disorder. Recurrent Miller Fisher syndrome is extremely rare, and all patients with recurrences have been adults. Although the optimal treatment for Miller Fisher syndrome has yet to be established, the typical therapy includes intravenous immunoglobulin or plasma exchange. The efficacy of steroids is still debated.
  
  
  METHODS
  We describe two children with recurrent Miller Fisher syndrome. Episodes occurred at the age of 11.5 and 13 years in patient 1 and at the age of 8 and 13 years in patient 2.
  
  
  RESULTS
  Clinical patterns of the first and recurrent episodes of Miller Fisher syndrome were overlapping. In both patients, steroids were effective in controlling clinical deterioration of Miller Fisher syndrome recurrences.
  
  
  CONCLUSIONS
  Recurrent Miller Fisher syndrome is a rare disorder that may occur in children. Our observations and a review of the literature suggest that there may be a small group of patients in whom steroids may be a therapeutic option when intravenous immunoglobulin fails to control clinical symptoms.
authors: Neurology-Immunology and Pediatric Endocrinology Unit, Department of Pediatrics, University of Siena, Siena, Italy; Department of Pediatrics, University of Siena, Siena, Italy. Electronic address: salvatore.grosso@unisi.it.
authors: Salvatore
authors: S
authors: Grosso
authors: Department of Pediatrics, University of Perugia, Perugia, Italy.
authors: Alberto
authors: A
authors: Verrotti
authors: Department of Pediatrics, University of Siena, Siena, Italy.
authors: Monica
authors: M
authors: Tei
authors: Department of Pediatrics, University of Siena, Siena, Italy.
authors: Sara
authors: S
authors: Cornacchione
authors: Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy.
authors: Fabio
authors: F
authors: Giannini
authors: Department of Pediatrics, University of Siena, Siena, Italy.
authors: Paolo
authors: P
authors: Balestri
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D019846:Miller Fisher Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D013256:Steroids
keywords: Guillaine-Barrè syndrome; demyelination; neuroimmunology; pediatrics; steroids