Investigators from University of Siena, Italy, describe 2 children with recurrent Miller Fisher syndrome. Episodes occurred at age 11.5 and 13 years in Patient 1 and at age 8 and 13 years in Patient 2. Both patients responded to treatment with steroids. Patient 1 presented with diplopia, unsteady gait and clumsiness. Neurologic examination showed ataxia, hyporeflexia, and ophthalmoplegia. Treatment with iv immunoglobulin was effective initially, but failed to prevent progressive weakness during the second attack that subsequently responded to steroid therapy. Patient 2 presented with paresthesia of hands and diplopia, ataxia, paresis of 6th and 7th cranial nerves, muscle weakness, and hyporeflexia. Recovery from both the initial and second attack followed steroid therapy. [1]

COMMENTARY. Recurrent Miller Fisher syndrome [2] is rare in childhood, and the second attack may be more aggressive and resistant to therapy. Steroids may be indicated if iv immunoglobulin is ineffective [3].