Novel Application of Transcutaneous Electrical Stimulation for Ophthalmoplegia in Miller Fisher Syndrome: A Case Report

We report the case of 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 applied over the bilateral sternocleidomastoid muscles and immediately followed by eye-movement exercises. Within three days, ocular motility began to improve, and after one month, only minimal left-eye abduction lag remained. Such neuromodulation of TENS might act on central and peripheral tiers of the oculomotor system and may have been temporally associated with faster recovery than expected in the natural course of the disease compared to the median three-month interval. This dramatic, time-associated 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 for faster recovery.