In Coma For Two months, Child Recovers From Rare Disorder
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04 January 2012
By Umesh Isalkar
It was in early October that Prathamesh Jadhav, a little over two and half years old then, recovered from a viral infection. Soon after, he began to experience weakness in his legs, would complain of pain and walk laboriously like an aged person.
His parents ignored the symptoms, which they blamed on his frail frame. A few days later, Prathamesh suffered paralysis of his right leg and within the next two hours, of his right hand. By early next day, which was October 8, he suddenly stopped breathing and slipped into a coma.
For the next 60 days, the boy was on artificial respiration – during the course of which, his heart arrested twice, his kidneys failed, infection set in and he bled through the windpipe.
Just three months short of turning three, Prathamesh suffered Guillain-Barre syndrome (GBS), an autoimmune disorder in which the body’s immune system attacks itself.
There is progressive weakness which starts in the lower limbs and ascends upwards and later involves muscles of the respiratory tract, neck and face. GBS attacks one in one lakh adult population, whereas it is one in 10 lakh children below five years.
Discharged from the hospital on December 20, Prathamesh celebrated his third birthday on January 1, 2012.
Paediatric intensivist Sagar Lad, who treated the child along with paediatrician Ram Dhongade at the Shaishav Clinic, Laxmi Road, said, “Till date, very few cases have been reported in Indian paediatric literature of such a young child affected by GBS, surviving such prolonged ventilation and recovering despite all odds with excellent neurological recovery.”
Prathmesh’s uncle Vijay Tayade, a small businessman in Market Yard, said that following the viral infection, the boy complained of weakness and pain in legs.
“One day, there was complete paralysis of the right leg and right hand and we rushed him to the hospital. On October 8, Prathamesh stopped breathing and slipped into a coma.”
On reaching the hospital, Prathamesh was immediately resuscitated and put on artificial respiration (ventilator).
“There was no strength in either the upper or lower limbs. Due to paralysis of the facial muscles, his face was twisted to one side and because of paralysis of respiratory muscles he was unable to breath. The diagnosis of GBS was confirmed after doing a few specific tests and then began the stormy 60 day battle for life,” Dhongade said.
For the first five days, Prathamesh was given intravenous immunoglobulin (IVIG). IVIG are ready-made antibodies that have been extracted from blood donations from 3,000 to 10,000 healthy donors.
After two days of artificial respiration, Prathamesh suffered his first cardiac arrest and his blood pressure dropped significantly. The second cardiac arrest followed a week later.
“Usually, a patient with GBS may suffer from autonomic nervous system imbalance in which the patient gets either very high or very low blood pressure. This sudden change in blood pressure can cause a renal as well as heart shut down. We managed this with adrenaline infusion which stabilised blood pressure and helped to regain functions of vital organs,” said Lad.
On the fifth day of being on ventilation, the child had to fight against bleeding inside the windpipe. “Due to secondary infection and abnormal blood clotting because of extended period of ventilation, any patient put on ventilation support suffers from bleeding through trachea (windpipe). We managed this by putting him on high pressure ventilator,” Lad said.
“Slowly, over a period of three weeks, he started regaining consciousness. After one and half months of ventilation, he started showing some response in the form of movements of the upper limb. At the end of two months, we were able to wean him off the ventilator,” said Lad, who has received special training in Australia to deal with such complex ailments in children.
During this period, paediatric neurologist Umesh Kalane was also involved in management and treatment.
It was the skill and dedication of the medical team at Shaishav clinic, Sant Dyaneshwar Medical Research Centre, located on Laxmi Road that finally saw Prathamesh regain consciousness after struggling for a month and a half.
“At the time of discharge, he was conscious, able to speak, listen, use both upper limbs and was making an effort to stand, indicating that he was regaining some power in the lower limbs,” said Prathamesh’s father Vishnu Jadhav, a farmer in Bisinghpur in Buldhana district.
Doctors are confident that Prathamesh will be able to stand normally within a fortnight. “As, in this disease, lower limb strength is regained last,” said Lad.Guillain-barré (Ghee Yan-Bah Ray) What Is Tt?
It is rare and can make a person very weak very quickly. It is an autoimmune disorder that consists of weakness and paralysis of many parts of the body, along with abnormal sensations. The illness presents in several ways, at times making the diagnosis difficult in the early stages. The specific cause is an autoimmune reaction. Research indicates that, the nerves of the person who has Guillain-Barré or a related syndrome, are attacked by the body's defence system against disease (antibodies and white blood cells)The Result
As a result of this attack, the nerve insulation (myelin) and sometimes even the covered conducting part of the nerve (axon) is damaged. This attack delays and changes the nerve messages, between the sender (the brain) and receiver (muscle). The abnormal sensations and weakness quickly follow. The affected individual is crippledThe Treatment
Treatment differs based on the cause which can be an bacterial or viral infection, vaccination, surgery, trauma or chemical exposure. The immune reaction to vaccination, surgery, stress or injury triggers the disease