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What Causes Speech Distortion And Breathing Problem In A Teenager?
Question: I saw your name in internet. You are one of the best neurologist in the country. I need your advice.I am from XXXXXXX My son of 18 years old is in ICU with ventilator support for the last seventeen days in XXXXXXX The day (18/07/2016) he was hospitalised, he was not having any strength in hand and legs. Speech was little bit distorted. Next day he started having breathing problem. Then he was put on ventilator. Doctor ( neurologist) diagnosed that he is having GBS. Next day IVIG administered for five days. Total 140 gram was administered based on his weight. After 12 days also no improvement noticed, neither in hands and legs nor in the breathing. Doctor has started second dose today 03/08/2016. Is the line of treatment ok ? How much time it will take to come out from ventilator and to fully recover?.Please advice me urgently.
Thanks
Thanks
Brief Answer:
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
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
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Second dose has already been started yesterday. When the first visible sign of improvement will be seen? Will the improvement will be first in respiratory system?
Brief Answer:
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)
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)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
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)
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)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Is there any process by which it can be checked that the damaged layer of nerves are getting regenerated?
Brief Answer:
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)
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)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Once again I want to consult with you. As I have already informed you second course of IVIG has been completed 10 days back. After thirty two days also there is no improvement. About six days back, keeping the ventilator at CPAP mode the physiotherapist did one exercise : At the end of exhalation, he exerted a little pressure on his chest, patient initiated the breathing. Initially he could sustain for ten seconds. Gradually he could sustain for about ten minutes. Is it some short of improvement? the exercise is now stopped as he is having now pneumonia. His neck movement has increased a little. Tongue movement seems to have increased. Anyway, Again I want to ask you how much time it will take to come out from venti. As everybody says, after administering IVIG, the disease stops further. How long time it takes to stop ? How the damaged nerves get recovered? Does the infection will delay his recovery?
Brief Answer:
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)
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)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Every doctors say that it will take time to recover. I also have started believing that and have faith that he will recover and it will take time may be months. It is severe form of GBS. How the damaged nerves will get regenerated? Is diet has got something to do ? If so what are all diet should be given. Will the infection in lungs delay the process of recovery? After he has been put on venti, still there was progression of nerve damage?
Brief Answer:
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)
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)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Today is 35th day in hospital with ventilator support. No improvement noticed. Lot of secretion is there. Left lung was suspected to be infected. Broncoscopy was done and sample of sputum was collected for further check. No growth noticed. He is having autonomic disorder which means heart beat and blood pressure fluctuates. Is it normal? Will this disorder move away? Because of pneumonia the exerciser which I reported to my earlier question was stopped for the last few days. Today it has been resumed. He has done for five minutes. I do not know whether this is any sign of improvement. You said rate of recovery is different to different person. But still how much time it may take. It is very difficult for us (parents) to keep patience.
Brief Answer:
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)
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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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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