Essay on How Bickerstaff Brainstem Encephalitis, Guillain-Barré Syndrome, and Miller Fisher Syndrome Overlap

Introduction

Bickerstaff’s Brainstem Encephalitis (BBE) and Miller Fisher syndrome (MFS) are similar in their traits, and both have the anti-GQ1b antibodies. It has also been found out that in some cases, patients with MFS may also have BBE and Guillain-Barré syndrome (GBS). This paper seeks to show that although BBE, GBS, and MFS have similar characteristics, they are distinct and also that they belong to the same disease spectrum.

Summary of article

The purpose of the study by ⁽¹⁾Puma et al. (2018) is to present a case of a patient with an overlie in GBS, MFS, and BBEwith lasting conduction blocks (CBs). The case involves a 61-year-old man with symptoms such as ataxia that indicated the presence of MFS. Further symptoms such as drowsiness and the presence of IgG anti-GQ1b antibodies showed that the patient also had GBS and BBE. Investigation showed that the CMAP readings rose between day 2 and day 128 of medicalization. After continued treatment, the patient had regular CMAP readings on day 240.

In conclusion, signs such as the presence of anti-GQ1b antibodies helped in identifying the overlap between MFS, BBE, and GBS in the patient in this case. It is also crucial to note the CBs that continued to last, indicate that the feebleness in the patient was caused by the continued attack on the nodal region of the patient’s body.

Discussion

Counterargument

⁽²⁾Shameem et al. (2013) argue that it can be challenging to differentiate BBE from MFS. According to ⁽²⁾Shameem et al. (2013), signs such as areflexia, ataxia, ophthalmoplegia, and facial palsy exist in BBE and MFS, making it difficult to differentiate them. Both diseases also have anti-GQ1b IgG antibodies. However, this may not be entirely true. Although BBE and MFS have some similar characteristics, they also have some distinct characteristics. According to ⁽¹⁾Puma et al. (2018), BBE and MFS are different in terms of consciousness disturbances and MRI abnormalities. BBE patients develop consciousness disturbances at an early age, and some have abnormal MRI signals in different parts of the brain. Therefore, the claim by ⁽²⁾Shameem et al. (2013) that it can be challenging to differentiate BBE from MFS does not hold. Nonetheless, it is essential to recognize that the two diseases are part of the same spectrum.

Argument

While reporting a case of a 61-year-old man with a case of overlapping MFS, BBE, and GBS, ⁽¹⁾Puma et al. (2018) claim that the finding of anti-GQ1b IgG antibodies in BBE and MFS patients is proof that the two conditions belong to the same disease spectrum known as anti-GQ1b antibody syndrome. According to ⁽¹⁾Puma et al. (2018), MFS, BBE, and GBS overlap in this spectrum. This claim is similar to the argument that ⁽³⁾Michev et al. (2018) makes that the presence of antiganglioside antibodies such as anti-GQ1b IgG is a common characteristic of diseases such as GBS, MFS, and BBE. ⁽³⁾Michev et al. (2018) say that the three diseases can be considered to be part of a unique spectrum of post-infectious encephalitis in which having anti-GQ1b IgG antibodies is a common characteristic.

Conclusion

In summary, BBE, MFS, and GBS have similar characteristics, such as the presence of antiganglioside antibodies in each. However, each of these three diseases also has some distinct characteristics that help in differentiating them. Also, the three diseases belong to one disease spectrum.

References

1. Puma A, Benoit J, Sacconi S, Uncini A. Miller Fisher syndrome, Bickerstaff brainstem encephalitis and Guillain-Barré syndrome overlap with persistent non-demyelinating conduction blocks: a case report. BMC neurology. 2018 Dec;18(1):101.
2. Raji Shameem Md, Sonpal N, Hamid M, Orsher S, Bhatia N, Waitzman Dm, Mandel S. Bickerstaff’s brainstem encephalitis: A rare variant of the anti-Gq1b antibody syndrome. Practical Neurology. 2013 Sep.
3. Michev A, Musso P, Foiadelli T, Trabatti C, Lozza A, Franciotta D, Simoncelli AM, Savasta S. Bickerstaff Brainstem Encephalitis and overlapping Guillain-Barré syndrome in children: Report of two cases and review of the literature. European Journal of Paediatric Neurology. 2018 Nov 20.