
What Causes Speech Distortion And Breathing Problem In A Teenager?

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I would prefer plasma pheresis.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your son's symptoms. I agree with the diagnosis and treatment plan in the initial period. IVIG is the safest and best treatment for GBS.
It is well known that some people do not improve with IVIG. In such cases, there are two options- first, give another course of IVIG, second, try PLASMAPHERESIS. In my patients, I go for plasmapheresis. This reasoning is based on the fact that if there was no improvement with first course of IVIG, there may not be improvement with the second course of IVIG too. However, I agree that, as per literature, giving second course of IVIG is also a correct option.
In plasmapheresis, the patients blood is purified, harmful antibodies are removes, and fresh plasma is given. This is similar to dialysis in patients with kidney failure.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist


Improvement should be seen in days to weeks.
Detailed Answer:
Thank you for getting back.
The improvement varies in different patients. Some patients improve within days, some take weeks.
First improvement should be seen in respiratory and shoulder muscles.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Antibiotics are needed.
Detailed Answer:
Thank you for getting back.
Secretion and Chest X ray are suggestive of chest infection (pneumonia). For that he needs antibiotics. Good chest physiotherapy is also needed.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Clinical examination is the best method of assessment.
Detailed Answer:
Thank you for getting back.
Assessment of motor power of affected muscles is the best method. Motor power is graded from 0 to 5 (0 is no strength and 5 is normal strength). With improvement, the motor power is expected to increase from 0 towards 5.
Nerve conduction studies can help up to a certain extent in assessing the improvement, but is not as reliable as clinical assessment of affected muscles.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Yes, there are some signs of improvement.
Detailed Answer:
Thank you for getting back with more information.
I have noted the additional details provided by you. These indicate minor improvement. The time taken for recovery varies between different patients. Some patients recover within one month, some others take six months. Here, two courses of IVIG has been given and the patient is still on ventilator. This is suggestive of a severe form of GBS. It may take a few more weeks to wean him from ventilator, and further 3-4 months to see good improvement in muscle power of arms and legs.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Physiotherapy is the mainstay of treatment.
Detailed Answer:
Thank you for getting back.
I agree with you that recovery will take time, as it is a severe form of GBS.
Any infection, including respiratory infection, would delay the recovery. So, the infection should be promptly treated.
Nerve regeneration is a natural process and occurs on own.
High protein diet would help in better recovery.
Disease progression in GBS can occur upto four weeks of illness, after that, generally, it does not get worse.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Autonomic dysfunction is not a good sign.
Detailed Answer:
Thank you for getting back with more information.
Autonomic dysfunction is not a good sign. Fluctuation of heart rate and blood pressure indicates severe GBS, and one of the factors that indicates a poor prognosis for recovery.
Pneumonia also delays recovery.
So, as of now, as you said, we do not see any signs of recovery. However, proper treatment of these two conditions would lead to slow recovery over several months.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

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