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Miller Fisher syndrome (MFS) is a localized variant of Guillain-Barré syndrome (GBS), characterized by ophthalmoplegia, areflexia, and ataxia. Recent neurophysiological studies have suggested that abnormal terminal axon dysfunction occurs in some cases of Miller Fisher syndrome and Guillain-Barrd syndrome. We present a rare case report of recurrent MFS with abnormal terminal axon dysfunction. To the best of our knowledge, this is the first case report of recurrent MFS with terminal axon dysfunction that persisted up to nine months after the initial presentation of the second attack with positive antiganglioside antibodies and full clinical recovery.

Purpose: The rationale for this case report is to assess the degree of congruency between the results of several advanced functional, metabolic, and structural neuroimaging techniques used in patients with MRI-negative focal epilepsy., Methods: We investigated the presurgical evaluation and post-operative outcome of a patient with intractable, extratemporal epilepsy. Because the habitual seizures in this patient could be easily induced, six, advanced, neurodiagnostic techniques were successively applied (SISCOM, ictal FDG-PET, ictal fMRI, postictal diffusion-weighted imaging, voxel-based morphometry, and MRS imaging)., Results: The findings for the neuroimaging methods investigated, within the left central region, were fairly congruent. Subsequent, invasive EEG recordings revealed a seizure-onset zone at the site where most of the neuroimaging had shown abnormal findings. The surgical removal of the epileptogenic zone, as defined by concordant neuroimaging and SEEG data, resulted in seizure-free postoperative outcome. Histopathological findings revealed mild focal cortical dysplasia., Conclusion: Great efforts should be made to combine most of the advanced neuroimaging methods in the preoperative assessment of non-lesional epilepsy surgery candidates.