[논문]A Case Study of a Patient with Diplopia and Bilateral Facial Palsy Due to Atypical Miller Fisher Syndrome: Treatment with Complex Korean Medicine

Park, Chae Hyun; Kang, Jae Hui; Ryu, Hwa Yeon; Jung, Ga Hyeon; Ku, Yong Ho; Lee, Hyun

doi:10.13045/jar.2020.00367

A Case Study of a Patient with Diplopia and Bilateral Facial Palsy Due to Atypical Miller Fisher Syndrome: Treatment with Complex Korean Medicine 원문보기

Journal of acupuncture research, v.38 no.1, 2021년, pp.66 - 71

Park, Chae Hyun (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Kang, Jae Hui (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Ryu, Hwa Yeon (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Jung, Ga Hyeon (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Ku, Yong Ho (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University) , Lee, Hyun (Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University)

Abstract ▼ AI-Helper

Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome characterized by ocular paralysis, ataxia, and insensitivity. This report describes the effect of Complex Korean Medicine Treatment (CKMT) on a patient previously diagnosed with MFS presenting with diplopia and facial palsy. The distance at which diplopia occurs, the diplopia questionnaire, the range of diplopia, the degree of facial paralysis, and the degree of ptosis were evaluated at the time of admission and weekly for 1 month. After receiving CKMT for 4 weeks the 62-year-old female had improved symptoms of diplopia, bilateral facial palsy and ptosis caused by MFS. These results show the significant association of MFS with facial paralysis and the improvement achieved with CKMT.

주제어

표/그림 (8)

표 Table 1. Treatment Intervention.
그림 Fig. 1. Scores from the diplopia questionnaire over treatment time. The score decreased to 13 points on July 16^th, 2020 from 25 points on June 18^th, 2020, showing improvement in the diplopia the patient experienced.
표 Table 2. Herbal Composition of 4 Herbal Medications for Daily Dosage.
그림 Fig. 2. Distance at which diplopia occurred over the treatment period. Diplopia was resolved within the measurable range in the forward and upward gaze. Diplopia was lost at 0.6 m in the downward and left gaze. During the right gaze, diplopia was lost at 0.12 m, but appeared at a distance beyond that.
그림 Fig. 3. Diplopia field. Compared with June 19^th, 2020, on July 16^th, 2020, when looking forward, upward, downward, and left, diplopia was resolved, and the range of diplopia on the right gaze was reduced by 2 cm.
그림 Fig. 4. Yanagihara score over the course of treatment. Compared with June 18^th, 2020, the score increased by 2 points on July 16^th, 2020.
그림 Fig. 5. Photographs of improvement in ptosis over the treatment period (June 18^th, 2020, June 25^th, 2020, July 2^nd, 2020, July 9^th, 2020, July 16^th, 2020).
그림 Fig. 6. Photographs of keratography. Normal findings in dry eye.

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

Evaluation of the treatment for MFS entails an assessment of eye movement, the distance at which diplopia occurs, and use of the diplopia questionnaire. This report describes the improvement in symptoms of diplopia and facial palsy after receiving complex Korean medical treatment (CKMT) at the Cheonan Korean Medicine Hospital of Daejeon University in a patient diagnosed with atypical MFS who had not shown improvement after Ⅳ.IG and steroid treatment received previously at Dankook University Cheonan Hospital.

제안 방법

20 × 30 mm stainless steel standardized and disposable (Eastern acupuncture equipment manufacturer, Boryung, Korea). Acupuncture was administered twice daily for 15 minutes: bilateral BL2, Ex-HN₄, TE23, GB1, BL1, Ex-HN₇, ST4, ST6, TE17, L14, ST36, and ST9. Electroacupuncture treatment was administered once daily for 15 min.
In a recent study, there was no clear conclusion about the effect of immunoglobulin treatment, however the study was small [5]. Evaluation of the treatment for MFS entails an assessment of eye movement, the distance at which diplopia occurs, and use of the diplopia questionnaire. This report describes the improvement in symptoms of diplopia and facial palsy after receiving complex Korean medical treatment (CKMT) at the Cheonan Korean Medicine Hospital of Daejeon University in a patient diagnosed with atypical MFS who had not shown improvement after Ⅳ.
The patient took herbal medication 3 times daily; Bojungikgitang- gamibang, Soyo-san, Samulgwibitang, and Kikukjihwangtang were given (Table 2).
the severity of diplopia [6]. The questionnaire evaluation was conducted a total of 5 times, once a week, from June 18^th, 2020, to July 16^th, 2020 (Fig. 1; Appendix A).
This patient was diagnosed with atypical MFS as a symptom of acute extraocular muscle palsy (which was 1 of the 3 main symptoms), and facial paralysis due to facial nerve palsy (a cranial nerve other than the ocular nerve). CKMT was administered during the 30 days of hospitalization.
To evaluate the changes in ptosis, photos were taken once a week. Photographs of ptosis taken on July 16^th, 2020, in the front view showed that the pupils were clearly more visible compared with photographs taken on June 18^th, 2020 (Fig.

대상 데이터

The acupoints were TE17, ST6, and ST9. Hominis placenta pharmacopuncture (Korean Pharmacopuncture Institute, Seoul, Korea) was administered just before acupuncture therapy in the afternoon.
Electroacupuncture treatment was administered once daily for 15 min. The machine used for electroacupuncture was STN-110 (Stratek, Seoul, Korea), set with a stimulation frequency of 3 Hz (Table 1).
The patient visited Cheonan Korean Medicine Hospital of Daejeon University. After hospitalization, steroid oral administration therapy was continued for 5 days.

성능/효과

paralysis [20]. In addition, unlike previous studies, this study evaluated the degree of diplopia according to the gaze direction and the patient showed satisfactory improvement.

참고문헌 (20)

Fischer M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med 1956;255:57-65.

상세보기
Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T. Clinical features and prognosis of Miller Fisher syndrome. Neurology 2001;56:1104-1106.

상세보기
Yuki N, Sato S, Tsuji S, Ohsawa T, Miyatake T. Frequent presence of anti-GQ1b antibody in Fisher's syndrome. Neurology 1993;43:414-417.

상세보기
Berlit P, Rakicky J. Miller Fischer syndrome. Review of the literature. J Clin Neuroophthalmol 1992;12:57-63.
Jung JW, Lee JH, Jung JH. The Characteristics and Prognosis of Miller-Fisher Syndrome. J Korean Ophthalmol Soc 2017;58:197-202.
Jonathan MH, Leske DA, Kupersmith MJ. New Methods for Quantifying Diplopia. Ophthalmology 2005;112:2035-2039.

상세보기
Won SY, Kim MJ, Cha JY, Jung ES, Cho HK, Yoo HR et al. Systematic Review of Korean Medicine for the Treatment f Sixth Cranial Nerve Palsy. Int Korean Med 2019;40:409-442. [in Korean].
Kim JH, Kwon MS, Jo DH, Jo HJ, Choi JE, Han JS et al. A Case Report of Diplopia after an Orbital Wall Fracture Treated with Korean Medicine Treatment. Acupuncture 2016;33:169-179.
Yanagihara N. Grading of Facial Palsy. Kulgar Medical Publications; 1977. p. 533-535.
Cheng KJ. Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician's Perspective. J Acupunct Meridian Stud 2014;7:105-114.

상세보기
Ryu JY, Lee KW, Cho MK, Cho HK, Yoo HR, Seol IC et al. Case Report: Miller Fisher Syndrome. J Intern Korean Med 2016;37:661-668. [in Korean].

원문보기 상세보기
Wang CY, Huang JH, Ye y, Xu XY. Therapeutic Effect of Miller Ficher Syndrome with Acupuncture and Drugs. Liaoning J Tradit Chin Med 2009;36:615-616. [in Chinese].
Li YF, Li T, Zhang DW, Xue H, Chen D, Li C et al. The comprehensive Therapy of Electroacupunture Promotes Regeneration of Nerve Fibers and Motor Function Recovery in Rats after Spinal Cord Injury. Evid Based Complement Alternat Med. 2018;2018:7568697.
Park JH. The Clinical Research of the Effectiveness of Pharmacopuncture Complex Therapy on Peripheral Facial Paralysis. Hominis Placenta Pharmacopuncture Therapy and Sweet Bee Venom Therapy. J Acupunct Res 2010;27:79-87.
Won JS, Chou CY, Cho AR, Kim CH. The Clinical Observation of Bell's palsy sequela. J Korean Orient Med Ophthalmol Otolaryngol Dermatol 2009;22:167-177.
Kim BH, Park JG, Kang SH, Kang DW, Nam HJ. The use of Lycii Fructus and Chrysanthemum Indicum in the Ophthalmology disease from literature and experimental studies review. J Korean Med Ophthalmol Otolaryngol Dermatol 2018;31:1-10.
Yoon YG, Dong-uibangje and Prescription Explanation, 2nd ed. Seoul (Korea): Uiseongdang Press; 2002. 516 p. [in Korean].
Jeong EJ, Choi DJ, Ko CN, Cho KH, Kim YS, Bae HS et al. A Case of MillerFisher Syndrome. J Korean Med 2000;20:98-105.
Kim HB, Jeong JK, Kim MK, Kim JI, Lee YJ, Jeon JH et al. A Case Report of a Patient with Miller Fisher Syndrome Treated with Traditional Korean Medicine. J Acupunct Res 2018;35:141-144.

원문보기 상세보기
Song MS, Yoon HW, Ko WS. Case of Delayed Facial Palsy and Dizziness in Miller-Fisher Syndrome. J Korean Med Ophthalmol Otolaryngol Dermatol 2019;32:254-261.

원문보기 상세보기

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증