Conclusions: Neuro-ophthalmic manifestations and disease course of pediatric MFS were similar to those of adult MFS as stated in the literature. of pediatric MFS were similar to those of adult MFS as stated in the literature. However, the presence of autonomic symptoms was higher and anti-GQ1b antibody positivity was lower in pediatric MFS than in adult MFS. = 0.01), ataxia (= 0.01), and autonomic symptoms (= 0.04) than adult MFS cases. Areflexia was a less dominant feature in pediatric MFS than in adult MFS (= 0.04). Regarding laboratory findings, pediatric individuals showed lower positivity in anti-GQ1b antibody screening (= 0.02) and higher albumin-cytologic dissociation ( 0.01) than adult individuals. The number of pediatric individuals who showed total improvement within a month was higher than that in adult individuals = 0.04). Table 2 Assessment between pediatric and Bosentan Hydrate adult Miller Fisher syndrome. = 11)= 36) 0.05, CSF = cerebrospinal fluid; NCS = nerve conduction study; IVIG = intravenous immunoglobulin; PP = plasmapheresis. 3.3. Literature Review No caseCcontrol Rabbit polyclonal to MST1R or cohort studies on pediatric MFS are available in the literature. Recently, Yoon et al. carried out a retrospective review of anti-GQ1b antibody syndrome in children, but it relied on Bosentan Hydrate serologic analysis [8]. Normally, 53 pediatric instances of 41 case reports were found, and the medical characteristics of the examined cases are shown in Table 3 [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49]. Details of individual instances were also available as product. Table 3 Demographics of pediatric Miller Fisher syndrome in the literature, and its assessment with pediatric MFS in our study. = 53)= 11)and infections were obvious in 21% and 8% of MFS individuals, respectively [50]. Berlit and Rakicky reported that 71.8% of MFS individuals experienced a preceding viral infection [51]. Yoon et al. shown that in Korean pediatric MFS instances, 72.7% had a preceding infection, and the majority of them had gastrointestinal symptoms [8]. In the literature review, 84.9% of patients experienced preceding illness, Bosentan Hydrate and upper respiratory infection was the most common infection in pediatric patients (46.7%). Our study showed that 10 (90.9%) individuals experienced preceding gastrointestinal or upper respiratory symptoms. One individual formulated MFS after an event of ear pain with fever with this study. Similarly, unusual infections such as acute pyelonephritis, acute otitis media, acute arthritis with viral illness, measles, and mumps were reported [15,27,36,37,40]. Interestingly, in this study, more pediatric MFS individuals offered autonomic symptoms than did adult individuals. Previously, Malhotra et al. reported that three pediatric individuals with MFS showed hypertension [9]. They suggested a possible association between autonomic instability and MFS in pediatrics. The literature review also exposed similar results: seven instances shown autonomic manifestations, primarily hypertension and tachycardia (13.2%, Table 3) [9,23,26,27]. Mori et al. reported that 16% of adult MFS individuals showed autonomic symptoms, but they were due to all micturition disturbances [52]. Acute ophthalmoplegia combined with autonomic symptoms, such as hypertension or tachycardia, could be helpful diagnostic hints for pediatric MFS. In the medical features of ophthalmoplegia, the prevalence of bilateral involvement at the initial check out in pediatric individuals was lower than that in adults. MFS has a progressive pattern in the early phase; the pattern of ophthalmoplegia may consequently differ depending on the timing of diagnosis. For instance, studies have shown six cases starting with unilateral external ophthalmoparesis and then distributing bilaterally as the disease progressed [13,14,16,18,30,41]. The incidence of bilateral involvement in MFS was expected to be part of the disease progression. We consequently infer the laterality may not be a distinctive feature of pediatric MFS. However, we would like to focus on that progressive ophthalmoplegia after preceding illness could be a helpful feature for MFS analysis in children. Pediatric MFS individuals had more ataxia than did adult MFS individuals. There was no subtype difference between pediatric and adult instances in our study, although most pediatric MFS individuals had the classic MFS. In general, pediatric individuals have limitations in expressing their symptoms compared to adult individuals. Therefore, we suggest that it might be helpful to closely observe the obvious sign ataxia in MFS analysis in pediatrics. Serological, immunological, and pathological evidence showed the inconclusive part of anti-GQ1b antibodies in MFS [53,54,55,56]. The positivity rate for anti-GQ1b antibodies has been reported as more than 80% in MFS. Consequently, testing.