背景:MillerFisher综合征(MFS)是格林-巴利综合征(GBS)的一种亚型,其特征是眼肌麻痹的三个组成部分,共济失调,和弹性反射。一些研究报告说,MFS是COVID-19疫苗接种的不良反应。我们的目标是对人口统计进行详细的评估,临床,以及接受COVID-19疫苗后患有MFS的受试者的临床特征。
方法:设计了一个彻底的搜索策略,和PubMed,WebofScience,和Embase进行了搜索以查找相关文章。每个筛选步骤进行两次,如果有分歧,咨询了另一位作者。提取了患者的不同特征和疫苗类型的数据。使用JoannaBriggs研究所(JBI)工具评估研究偏倚的风险。
结果:在这项研究中,从15个病例研究中确定了15个患者。患者的中位年龄为64岁,范围为24至84岁。10名患者(66.6%)是男性,辉瑞公司占注射疫苗的46.7%。从疫苗接种到症状发作的中位时间为14天,从7到35天不等。此外,14例患者有眼部体征,78.3%(11/14)的眼部表现为双侧。在神经系统疾病中,除了MFS三合会,面部无力或面神经麻痹是最常见的副作用,在7名受试者中(46.7%)。静脉免疫球蛋白(IVIg)是最常用的治疗方法(13/15,86.7%)。六名患者接受0.4g/kg,四名患者接受2g/kg。患者在医院停留了5到51天。没有报告致命的结果。最后,40.0%(4/15)的患者完全恢复,其余的经历了改善。
结论:COVID-19免疫后MFS预后良好。然而,在一些研究中,从疾病出现到治疗的时间间隔较长,这表明作为疫苗接种的不利影响,应更多地关注MFS。由于具有挑战性的诊断,在最近有COVID-19疫苗接种史和任何眼部疾病的患者的鉴别诊断列表中,必须考虑MFS,共济失调,或者反应能力丧失,特别适合60多岁和70多岁的男性患者。
BACKGROUND: Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome (GBS) which is characterized by the three components of ophthalmoplegia, ataxia, and areflexia. Some studies reported MFS as an adverse effect of the COVID-19 vaccination. We aimed to have a detailed evaluation on demographic, clinical, and para-clinical characteristics of subjects with MFS after receiving COVID-19 vaccines.
METHODS: A thorough search strategy was designed, and PubMed, Web of Science, and Embase were searched to find relevant articles. Each screening step was done by twice, and in case of disagreement, another author was consulted. Data on different characteristics of the patients and types of the vaccines were extracted. The risk of bias of the studies was assessed using Joanna Briggs Institute (JBI) tools.
RESULTS: In this study, 15 patients were identified from 15 case studies. The median age of the patients was 64, ranging from 24 to 84 years. Ten patients (66.6%) were men and Pfizer made up 46.7% of the injected vaccines. The median time from vaccination to symptoms onset was 14 days and varied from 7 to 35 days. Furthermore,14 patients had ocular signs, and 78.3% (11/14) of ocular manifestations were bilateral. Among neurological conditions, other than MFS triad, facial weakness or facial nerve palsy was the most frequently reported side effect that was in seven (46.7%) subjects. Intravenous immunoglobulin (IVIg) was the most frequently used treatment (13/15, 86.7%). Six patients received 0.4 g/kg and the four had 2 g/kg. Patients stayed at the hospital from five to 51 days. No fatal outcomes were reported. Finally, 40.0% (4/15) of patients completely recovered, and the rest experienced improvement.
CONCLUSIONS: MFS after COVID-19 immunization has favorable outcomes and good prognosis. However, long interval from disease presentation to treatment in some studies indicates that more attention should be paid to MFS as the adverse effect of the vaccination. Due to the challenging diagnosis, MFS must be considered in list of the differential diagnosis in patients with a history of recent COVID-19 vaccination and any of the ocular complaints, ataxia, or loss of reflexes, specially for male patients in their 60s and 70s.