Therapeutics
Fred Yi-Shueh Chen, MD
Attending Physician
Ditmanson Medical Foundation Chia-Yi Christian Hospital
Chiayi City, Chiayi, Taiwan (Republic of China)
Ying-Chi Huang, MD
Resident Physician
Taipei Medical University Hospital
Taipei, Taipei, Taiwan (Republic of China)
We report a 62-year-old woman with Miller Fisher syndrome (MFS) whose severe bilateral ophthalmoplegia showed no improvement after four weeks of standard care consisting of intravenous immunoglobulin and physiotherapy. High-frequency transcutaneous electrical nerve stimulation (TENS) was then applied over the bilateral sternocleidomastoid muscles followed by immediate eye-movement exercises. Within three days ocular motility began to improve, and by one month only a minimal left-eye abduction lag remained. Natural course to fully recovery was reached ahead of time compared to the median three-month interval. This dramatic, time-locked improvement highlights the novelty of cervical TENS as a potential accelerator for recovery in MFS-related ophthalmoplegia. To the best of our knowledge, research involving the use of TENS in MFS-related ophthalmoplegia is limited and our case demonstrates the feasibility and safety of TENS with advancement of recovery time.
Discussions:
TENS delivered to the sternocleidomastoid muscles offers plausible means of accelerating recovery from MFS-related ophthalmoplegia by acting on both central and peripheral tiers of the oculomotor system. Herein, we assume the peripheral and central factors interplay to the accelerated recovery of our patient. The resulting relaxation of suboccipital, peri-orbital and cervical musculature reduces passive drag on the globe, lowers vergence effort and enables the patient to execute residual eye movements with less mechanical resistance. In parallel, experimental work in neuropathic and demyelinating models shows that repeated transcutaneous stimulation can heighten nerve-growth-factor expression, enlarge axon caliber, promote remyelination and curb pro-inflammatory cytokines, thereby creating repair of the anti-GQ1b-injured cranial nerve terminals characteristic of MFS.
Conclusions:
This case demonstrates that adding cervical TENS to standard care was followed by a markedly faster and functionally meaningful recovery of ophthalmoplegia in Miller Fisher syndrome than would be expected from the disease’s typical natural history, which averages about three months to resolution.
