Rare syndrome attacks mobility
Young boy battles Guillian- Barré Syndrome
By Rachel E. Sheeley
Staff writer
This spring, 4-year-old Brandon Pickering complained that his leg hurt and that he didn't want to walk.
His family merely thought his leg had gone to sleep. However, within a few days, Brandon was nearly paralyzed by a rare illness, Guillian-Barré Syndrome.
After spending a month in Indianapolis hospitals, Brandon is getting back on his feet at home in Richmond with the aid of therapy at Reid Hospital.
"Things are going pretty good. Brandon is walking without a walker now," said his mother, Mara Pickering. "He only uses the walker when he has to go a long distance. He still uses a wheelchair when there's lots of walking involved.
"We've come a long way," Mara said.
It's certainly different from mid-March when one night, Brandon got up to go the bathroom and fell.
"His legs were like rubber," Mara remembers.
Not knowing the problem, she took Brandon to the doctor on March 14. He fell three times walking into the doctor's office. Doctors first thought he had the flu and sent him home.
That Brandon had Guillian-Barré Syndrome would not be apparent for several more days.
The syndrome's rarity often makes it difficult to diagnose. It develops in one or two children or adults among 100,000 each year -- less than a few dozen cases annually in Indiana.
In Guillian-Barré , the body's immune system attacks part of the peripheral nervous system.
Early symptoms are tingling in the extremities, as if the leg or foot is asleep; weakness, numbness, pain and paralysis. The paralysis is ascending, starting at the lowest part of the body -- legs, feet -- and moving up, said Dr. Bhwan Garg, an Indiana Univeristy School of Medicine professor of neurology.
Children, Garg said, may complain of aches and pains, and may appear clumsy or uncoordinated. Those symptoms don't give a physician a clear-cut diagnosis.
"Most often diagnosis is based on clinical symptoms," Garg said.
Garg said the syndrome reaches its peak within about two weeks.
The day after Brandon saw his physician, he couldn't walk around the living room without falling, Mara said.
This time, they went to the emergency room. After a series of tests, doctors recommended that Brandon see a pediatric neurologist. He was rushed by ambulance to Riley Hospital for Children in Indianapolis.
Tests and examinations there didn't provide an immediate diagnosis. Cancer was even mentioned.
"By then, he couldn't walk. He had trouble rolling over," Mara said. "We started praying."
Four days later, the paralysis had set in, helping solidify the diagnosis. "He was like a baby. Basically, he was an infant," Mara said.
Doctors treat the immune system's reaction to reverse the attacking antibodies and cleanse the blood, Garg said. Brandon's intensive immunoglobulin treatment, with intravenous injections of proteins, lasted five days.
"The earlier you can intravene, the better the outcome," Garg said. "It keeps getting better and better."
The cause of Guillian-Barré Syndrome is unknown, but it often occurs after a respiratory or gastrointestinal viral infection. Within a few weeks of when he became ill, Brandon had inflamed, swollen tonsils and strep throat, his mother said. He was supposed to have his tonsils removed March 31.
With the syndrome's progression stopped, Brandon was transferred to Methodist Hospital for extensive rehabilitation therapy.
"The weaker you are at the maximum point, the longer it takes to recover," Garg said. "You just have to keep working at it. It's very nice to see children that are so weak get better."
Dr. Jennifer Crocker is the pediatric physical medicine and rehabilitation specialist and an attending physican at Riley and Methodist hospitals who worked with Brandon.
When she met him, he was complaining of leg pain, muscle weakness and refusing to walk.
"We really focused on getting him stronger... getting him to regain his confidence," Crocker said. "We used pretty much all of our team on Brandon."
That includes a neuropsychologist, nurses, and occupational, physical and music therapy.
"We involved the family so much. His family was really interacting and had a really positive outlook," Crocker said. "That made him gain so much."
"We have to get him to play games a lot to get him to do the therapy and take his medicine," Mara said.
As a reward after each successful therapy session at Methodist, Brandon was able go for a ride on the elevated monorail, or people mover, connecting the Clarian hospitals in Indianapolis.
His mother made the ride with a gleeful Brandon almost daily, but she disliked every minute.
"I'm not real good on heights and rides," Mara said.
Brandon, Crocker said, was a pretty typical case to treat.
The syndrome disrupts the sheath around the nerves, Crocker said. The sheath is similar to the insulation around a telephone cable. When that insulation, or sheath, is damaged, it makes the transmission slower.
"Nerves grow back at about a milimenter a day. It takes a long time to go back into the legs," Crocker said.
"I anticipate he'll recover very well. It takes a long time," Crocker said. "Only half of the people that contract Guillian-Barré have residual neurological deficits to the point that it's a disability."
Crocker said that developments in rehabilitation have turned recoveries like Brandon's into a more definitive process.
After three weeks of rehabilitation under Crocker's supervision, Brandon came home April 15. Since then, he has been involved in a regimen of physical, occupational and speech therapy at Reid Hospital.
The first time Mara watched Brandon stand in physical therapy was emotional.
"It did bring tears to my eyes -- I just bawled," Mara said.
"The littlest thing he does, it's like a brand new baby. It's just amazing."
In a recent physical therapy session, Brandon took tentative steps on the heavily padded floor mat before plopping down with a giggle.
However, pulling his knees to his chest and stretching his legs made him complain.
And a few minutes later, he was back in good humor, squealing and swinging in a hammock style seat that is blue like Superman's cape.
"We've just put everything in God's hands," she said. "He is getting stronger and he is getting better. It's just going to be a long process -- a long road for him of a lot of work.
http://www.pal-item.com/
By Rachel E. Sheeley
Staff writer
This spring, 4-year-old Brandon Pickering complained that his leg hurt and that he didn't want to walk.
His family merely thought his leg had gone to sleep. However, within a few days, Brandon was nearly paralyzed by a rare illness, Guillian-Barré Syndrome.
After spending a month in Indianapolis hospitals, Brandon is getting back on his feet at home in Richmond with the aid of therapy at Reid Hospital.
"Things are going pretty good. Brandon is walking without a walker now," said his mother, Mara Pickering. "He only uses the walker when he has to go a long distance. He still uses a wheelchair when there's lots of walking involved.
"We've come a long way," Mara said.
It's certainly different from mid-March when one night, Brandon got up to go the bathroom and fell.
"His legs were like rubber," Mara remembers.
Not knowing the problem, she took Brandon to the doctor on March 14. He fell three times walking into the doctor's office. Doctors first thought he had the flu and sent him home.
That Brandon had Guillian-Barré Syndrome would not be apparent for several more days.
The syndrome's rarity often makes it difficult to diagnose. It develops in one or two children or adults among 100,000 each year -- less than a few dozen cases annually in Indiana.
In Guillian-Barré , the body's immune system attacks part of the peripheral nervous system.
Early symptoms are tingling in the extremities, as if the leg or foot is asleep; weakness, numbness, pain and paralysis. The paralysis is ascending, starting at the lowest part of the body -- legs, feet -- and moving up, said Dr. Bhwan Garg, an Indiana Univeristy School of Medicine professor of neurology.
Children, Garg said, may complain of aches and pains, and may appear clumsy or uncoordinated. Those symptoms don't give a physician a clear-cut diagnosis.
"Most often diagnosis is based on clinical symptoms," Garg said.
Garg said the syndrome reaches its peak within about two weeks.
The day after Brandon saw his physician, he couldn't walk around the living room without falling, Mara said.
This time, they went to the emergency room. After a series of tests, doctors recommended that Brandon see a pediatric neurologist. He was rushed by ambulance to Riley Hospital for Children in Indianapolis.
Tests and examinations there didn't provide an immediate diagnosis. Cancer was even mentioned.
"By then, he couldn't walk. He had trouble rolling over," Mara said. "We started praying."
Four days later, the paralysis had set in, helping solidify the diagnosis. "He was like a baby. Basically, he was an infant," Mara said.
Doctors treat the immune system's reaction to reverse the attacking antibodies and cleanse the blood, Garg said. Brandon's intensive immunoglobulin treatment, with intravenous injections of proteins, lasted five days.
"The earlier you can intravene, the better the outcome," Garg said. "It keeps getting better and better."
The cause of Guillian-Barré Syndrome is unknown, but it often occurs after a respiratory or gastrointestinal viral infection. Within a few weeks of when he became ill, Brandon had inflamed, swollen tonsils and strep throat, his mother said. He was supposed to have his tonsils removed March 31.
With the syndrome's progression stopped, Brandon was transferred to Methodist Hospital for extensive rehabilitation therapy.
"The weaker you are at the maximum point, the longer it takes to recover," Garg said. "You just have to keep working at it. It's very nice to see children that are so weak get better."
Dr. Jennifer Crocker is the pediatric physical medicine and rehabilitation specialist and an attending physican at Riley and Methodist hospitals who worked with Brandon.
When she met him, he was complaining of leg pain, muscle weakness and refusing to walk.
"We really focused on getting him stronger... getting him to regain his confidence," Crocker said. "We used pretty much all of our team on Brandon."
That includes a neuropsychologist, nurses, and occupational, physical and music therapy.
"We involved the family so much. His family was really interacting and had a really positive outlook," Crocker said. "That made him gain so much."
"We have to get him to play games a lot to get him to do the therapy and take his medicine," Mara said.
As a reward after each successful therapy session at Methodist, Brandon was able go for a ride on the elevated monorail, or people mover, connecting the Clarian hospitals in Indianapolis.
His mother made the ride with a gleeful Brandon almost daily, but she disliked every minute.
"I'm not real good on heights and rides," Mara said.
Brandon, Crocker said, was a pretty typical case to treat.
The syndrome disrupts the sheath around the nerves, Crocker said. The sheath is similar to the insulation around a telephone cable. When that insulation, or sheath, is damaged, it makes the transmission slower.
"Nerves grow back at about a milimenter a day. It takes a long time to go back into the legs," Crocker said.
"I anticipate he'll recover very well. It takes a long time," Crocker said. "Only half of the people that contract Guillian-Barré have residual neurological deficits to the point that it's a disability."
Crocker said that developments in rehabilitation have turned recoveries like Brandon's into a more definitive process.
After three weeks of rehabilitation under Crocker's supervision, Brandon came home April 15. Since then, he has been involved in a regimen of physical, occupational and speech therapy at Reid Hospital.
The first time Mara watched Brandon stand in physical therapy was emotional.
"It did bring tears to my eyes -- I just bawled," Mara said.
"The littlest thing he does, it's like a brand new baby. It's just amazing."
In a recent physical therapy session, Brandon took tentative steps on the heavily padded floor mat before plopping down with a giggle.
However, pulling his knees to his chest and stretching his legs made him complain.
And a few minutes later, he was back in good humor, squealing and swinging in a hammock style seat that is blue like Superman's cape.
"We've just put everything in God's hands," she said. "He is getting stronger and he is getting better. It's just going to be a long process -- a long road for him of a lot of work.
http://www.pal-item.com/
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