BACKGROUND AND OBJECTIVE: Miller-Fisher syndrome (MFS) is considered the most 
common variant of Guillain-Barré syndrome (GBS) and is characterized by the 
clinical triad of ophthalmoplegia, ataxia and areflexia. Respiratory involvement 
and relapses are unusual. Patients with MFS usually have a good recovery and no 
residual deficits. We describe the clinical features, associated infections and 
evolution in eight patients with MFS.
PATIENTS AND METHOD: Eight cases of MFS and sixty-one of GBS were studied 
between 1994 and 2003. All cases showed the clinical triad of MFS without major 
limb weakness or other signs suggestive of CNS involvement.
RESULTS: The proportion of MFS with respect to GBS during the same period was 
13.1%. Four had a positive serology for Epstein-Barr virus, Salmonella 
enteritidis, Chlamydia pneumoniae and Mycoplasma pneumoniae. Our cases showed 
facial palsy (75%), dysphagia (75%), pupillary abnormalities (37.5%) and 
ventilation support (37.5%). Antiganglioside antibodies, determined in three 
cases (4 episodes), were positive [GQ1b (50%) and GD1b (50%)]. In all cases, 
there was a markedly reduced amplitude of the distal sensory as well as frequent 
axonal degeneration signs. The oldest three patients relapsed and required 
ventilation support.
CONCLUSIONS: We report for the first time an association between S. enteritidis 
and C. pneumoniae and MFS. Older patients in our series suffered a faster 
disease progression with need of ventilation support. We conclude that an older 
age correlates with poor prognosis and relapses.