Miller Fisher syndrome following COVID-19 vaccines: A scoping review

Background and Purpose Miller Fisher syndrome (MFS), a variant of Guillain-Barre Syndrome (GBS), could be underestimated in evaluations of its adverse events (AEs) following COVID-19 vaccination. We aimed to identify and characterize MFS following COVID-19 vaccination. Materials and Methods Relevant studies reported on during the COVID-19 pandemic were identified in the MEDLINE, Embase, and other databases. Results Nine cases of MFS following COVID-19 vaccination from various regions were included. Unlike MFS following COVID-19 infection, patients with MFS following COVID-19 vaccination frequently presented with anti-GQ1b antibody positivity (44%, 4/9). Unlike GBS following COVID-19 vaccination, only two of nine (22%) cases of MFS following COVID-19 vaccination had developed after viral-vector-related vaccine administration. Conclusions Miller Fisher syndrome following COVID-19 vaccination seems to have a different pathophysiology from MFS following COVID-19 infection and GBS following COVID-19 vaccination. This neurological syndrome with a rare incidence and difficulty in diagnosis should be considered an AE of COVID-19 vaccination.

Automated summary

This study aimed to identify and characterize Miller Fisher syndrome (MFS) following COVID-19 vaccination. The findings suggest that MFS following COVID-19 vaccination has different pathophysiology compared to MFS following COVID-19 infection and Guillain-Barre Syndrome (GBS) following COVID-19 vaccination. Considering the rare incidence and diagnostic challenges of this neurological syndrome, it should be recognized as an adverse event of COVID-19 vaccination.