You may be even more surprised to learn that while GBS is rare (incidence is about 2 per 100,000 cases), Cook Children's neurologists see between 6 to 10 cases per year. 

To learn more about GBS, we spoke to Stephanie Acord, M.D., a neurologist at Jane and John Justin Neurosciences Center. 

1. What is GBS?

It is an auto-immune process in which your immune system starts attacking the myelin which is the protective coating that surrounds your nerves. As a result, the information needing to get down the nerve to communicate with other parts of the body is slowed or unable to occur.

2. What are the causes?

Most common cause is almost always post-infectious, either viral or bacterial. Most common bacterial cause is Campylobacter jejuni which causes a gastrointestinal illness. It is not an infection itself and is not contagious. Symptoms usually start within a few weeks of the illness. Occasionally, it can be associated with vaccinations or post surgically.

3. What are the symptoms?

Symptom onset is usually relatively rapid and can include: progressive, ascending weakness (starts in feet and maybe hands and spreads gradually up the legs, arms and trunk), abnormal sensations such as pain, tingling, numbness and pins and needles, and autonomic instability (abnormal heart rate, blood pressure, temperature stability, breathing rate)

In more severe cases, difficulty breathing, facial weakness, trouble swallowing, and bowel/bladder dysfunction.

Peak of symptoms is usually within 2-3 weeks after onset.

4. What is the treatment?

IVIG is the treatment of choice and in more severe cases may require plasmapheresis. The sooner treatment is initiated the better the outcome. We prefer for treatment to start within 7-10 days of onset of symptoms.

Definition of IVIG: Immunoglobulins are special proteins in the blood. They fight infections. Some white blood cells make them. They are also known as antibodies. They are part of the immune system. With immunoglobulin therapy (IVIg), these proteins are donated from a healthy person. They are then given to you through an IV.

5. Is there an age range when you are more susceptible to it?

Peak age for onset of GBS is 38-40 years of age, but any age may be affected.

6. Does it impact children differently than adults?

The type of symptoms and response to treat is usually similar in children and adults

7. When should you see a doctor?

Any quick onset of abnormal sensations and/or weakness that is worsening needs to be evaluated. If the weakness is progressing quickly, may need to be evaluated in emergency department. Many times, people have difficulty with ambulating.

8. Are there different types of GBS?

There are axonal variants such as AMAN (acute motor axonal neuropathy) and AMSAN (acute motor and sensory axonal neuropathy) in which the immune system is attacking the membrane of the nerve itself not the protective coating. With AMAN, you do not usually have sensory disturbances associated with the disease. AMSAN can look very similar to GBS and there has been some debate in the past if they are the same or different diseases. AMSAN usually has a more rapid progression of symptoms over days and can take longer to recover.

Miller Fisher syndrome is onset of weakness that usually starts in the face and includes difficulty with moving the eye muscles leading to droopy eyelids and double vision, ataxia which is unsteadiness and incoordination, and decrease in your reflexes. Weakness can spread to rest of body in a more of a descending pattern. This should not be confused with botulism which is also a descending weakness but usually also affects the pupils.

There is also tick paralysis which can look like GBS so need to also look for tics on the body if have similar symptoms.

9. How rare is it to get it later in like like Travis Frederick?

It is common to get it in the adult age. Peak age for onset of GBS is 38-40 years of age.

10. Once you’ve had it, can it recur? Is it something that lasts forever?

There is a chronic form of GBS called CIDP or chronic inflammatory demyelinating polyradiculoneuropathy in which progression of symptoms continues at least 8 weeks and can be more difficult to treat. Most of the time, GBS is an illness you only develop once. If symptoms recur, then again, it may be that you have the chronic form that will need long term immunosuppressive or immunomodulating medications.

Most people have full or near full recovery of symptoms but this can take months or for more severe cases even years.

The CDC is monitoring nearly 300 pregnant women with Zika in the U.S. states, territories

Senate Passes Zika Bill That Will Go Nowhere Fast

Every time she sees a new headline about Zika, Mary Suzanne Whitworth, M.D., worries that the public is being inundated with scary news that is unlikely to affect them.

The medical director of Infectious Diseases at Cook Children’s knows that the more Zika stays in the headlines, the more fear will grow in people about the virus. And she expects the concern about the virus to increase during summer as mosquitos become more widespread.

Dr. Whitworth wants people to take the necessary measures to fight against Zika, but cautions parents to balance their fears with a common sense approach to the virus.

“Zika is very rarely found to be fatal,” Dr. Whitworth said. “It often causes a flu-like illness and many people who become infected with the Zika virus won’t even know they have it because they won’t have symptoms.”

Zika is not a bacterial disease that can be spread the same way as an illness such as strep throat. Zika is transmitted through mosquitoes or through sexual transmission.

The illness is usually mild with symptoms lasting for several days to a week. The most common symptoms of Zika are fever, rash, joint pain or red eyes (conjunctivitis). Other symptoms include muscle pain and headache.

So most of us won’t even know we have Zika or if we do, it will basically be the same as having a cold or possibly the flu for a few days.

That’s for the majority of people, but there are serious issues that can go along with some cases of Zika.

Microcephaly has been linked to the Zika virus. Microcephaly is a medical term for an abnormally small head. Between 2001 and 2014, Brazil had, on average, about 163 cases of microcephaly a year, but since 2015 things have taken a dramatic turn for the worse with more than 1,000 cases confirmed.

Zika virus can be spread to pregnant women through the bite of an infected mosquito and through sex. Pregnant women are advised to take precautions to protect themselves from Zika. Click here to learn more.

Guillain-Barré syndrome is a condition that has also been linked to Zika. GBS can affect people of any age, although rare in infants and toddlers. GBS symptoms usually begin with achiness of the muscles or burning or tingling of the feet and legs. GBS can cause the loss of the ability to walk and involve the diaphragm and breathing muscles which can be life threatening.

While microcephaly and GBS are newly linked to Zika, Dr. Whitworth says Cook Children’s has experience recognizing and treating both conditions.

“All of our neurologists are prepared to see patients with microcephaly and Guillain-Barré,” Dr. Whitworth said. “They already see these patients and have experience caring for them.”

Dr. Whitworth understands the fear of the unknown that comes with a new virus. But she says people should be diligent in protecting themselves from mosquito bites and that the CDC is monitoring the situation, as well as Tarrant County Public Health locally.

“The Centers for Disease Control and Prevention (CDC) is keeping up with this on an hourly basis and monitoring this and will keep us informed,” Dr. Whitworth said. “It's important for people to remember that sexual transmission, mother to fetus and blood transfusion are the only person-to-person routes to get Zika. Currently, there's no casual contact transmission that happens person-to-person."

Previous articles on Zika:

• Should we be afraid of Zika?
• Guillain-Barré syndrome: Are you at risk?
• Zika virus confirmed in Tarrant County
• 11 facts about the Zika virus

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

“Everything we look at with this virus seems to be a bit scarier than we initially thought,” said Dr. Anne Schuchat, a deputy director at the U.S. Centers for Disease Control and Prevention.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s knows that this news conference will increase the fear many already feel about Zika, but she points to a few facts to calm our nerves or at least let us take precautions to be safe:

1. Local transmission of the Zika virus from a mosquito hasn’t been documented in the United States. Zika virus has been reported in travelers returning to the U.S.
2. Pregnant women should consider not traveling to any area where Zika virus transmission is ongoing. Women who are trying to become pregnant should consult with their doctor.
3. Zika can be sexually transmitted. Women who are pregnant should not have sex with their partner if he has Zika. It is unknown how long the virus is present in semen.
4. The virus has been linked to the Guillain-Barré syndrome, which can cause paralysis.

The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosquitoes that spread dengue and chikungunya.

Those mosquitoes have been in the states for years, but we have not seen a massive outbreak in this country.

Dr. Whitworth said the reason why those mosquito-borne illnesses have not spread as much in this country may be as simple as improved mosquito vector control and air conditioning.

With more air conditioned homes, people stay inside more and don’t sleep with the windows open or go outside as much. The other key may be the measures taken to prevent mosquito bites, such as wearing insect repellant and sprays.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Warren Marks, M.D., a neurologist and medical director of the Movement Disorders and Rehabilitation Programs at Cook Children’s, says he sees a dozen or more cases often in clusters.

“Influenza can be a trigger, so flu season often triggers some cases,” Dr. Marks said. “There have been some cases associated with mostly older flu vaccines, however in general, immunizations are safe and should be given as recommended. If you are concerned that your child is having progressive weakness, they should be seen by a physician.”

GBS is a condition that can follow many different infections. The process starts after the infection activates the immune system. Sometimes part of the bacteria or virus can look like our own nerves. If this happens, our immune systems can mistakenly attack those nerves which can lead to weakness or paralysis.

At this time, Dr. Marks is not ready to say there’s a relationship to GBS and the ZIka virus. Although it’s not out of the possibility – “there are literally thousands of potential triggers for Guillian Bare’. It is a nonspecific response to an infection.”

GBS can affect people of virtually any age, although it is rare in infants and toddlers. GBS symptoms usually begin with achiness of the muscles or a burning or tingling of the feet and legs.

“Weakness follows, beginning in the feet and progressing up the body, usually over the course of a few days,” Dr. Marks said. “It can occasionally happen more quickly. GBS can involve the diaphragm and breathing muscles which can be life threatening.”

In the mildest cases, monitoring of progress in the hospital is sufficient. If there is loss of ability to walk 100 feet or the weakness is progressing and breathing is endangered, the treatment is usually a five day course of IVIG (intravenous immunoglobulin). Steroids and plasma exchange are other options.

Related articles:

• Zika virus confirmed in Tarrant County
• 11 facts about the Zika virus
• Zika: From nuisance to genuine threat to public health

About the source

Warren Marks, M.D., is one of the the first two Endowed Chairs at Cook Children’s. Dr. Marks joined Cook Children’s in 1988 and today serves as the medical director for the Movement Disorder and Neurorehabilitation Program. Learn more about Dr. Marks and the contributions he's made to Cook Children's here.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at thedocsmitty@cookchildrens.org.

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.

Breaking news concerning the weirdest week in celebrity-infectious disease history:

Peyton Manning helped lead the Broncos to victory despite suffering from a flu-like illness.

Sidney Crosby and multiple other National Hockey League stars have been diagnosed with mumps.

Angelina Jolie missed press events for the release of Unbroken, a movie which she directed, because she was diagnosed with chicken pox.

Maybe it is not breaking news. In fact, I’m pretty confident that they will all recover without any issues. Most people with any of these three diseases do.

We so rarely see mumps and chicken pox that we often forget how people used to suffer severe consequences from these diseases.

Here’s a quick reminder of some of the problems people can have as a result of these infections:

Flu

We have talked a lot about flu and flu vaccination in the past few weeks. Most children with the flu will have fever, cough, congestion and body aches,but will recover without incident in three to five days.

What do we need to watch for?

The most common problems with flu are dehydration and wheezing or difficulty breathing (especially in children with asthma).

A couple of more rare complications:

Pneumonia - Children can have viral pneumonia or a “secondary” bacterial pneumonia after the flu. (Secondary means that it comes after and as a result of having the flu. Think of it like the flu made the lungs weaker and more likely to get a different kind of infection.)

Nervous system involvement - These are rare but can involve confusion (caused by encephalitis-which is inflammation of the lining of the brain) and weakness (Guillain-Barré syndrome).

Mumps

Most children with mumps have low grade fever, fatigue, headache and muscle soreness. These symptoms are followed quickly by the most characteristic sign of mumps which is swelling of a gland in the cheek, called the parotid gland. The infection is typically more severe in adults than children.

What do we need to watch for?

Orchitis - This is a mumps infection involving the testicles. It is the most common complication in adolescent and adult males and can lead to sterility. A similar infection can occur in girls in the ovaries but is less common.

Nervous system involvement-Infected persons can have meningitis which causes fever, headache and neck pain. In addition, prior to vaccination mumps was one of the most common causes of deafness in children.

Chicken Pox

Because most of us had chicken pox and only suffered fever and the characteristic red, itchy rash, it is sometimes difficult to understand why we are vaccinating against the virus. Fortunately, that is the case for most children who contract the disease.

What do we need to watch for?

Skin infections - Because staph skin infections are so common now (and often resistant to some antibiotics), I am glad that we have a vaccine to prevent chicken pox. Any open sore, especially one that children are scratching is prone to infection.

Best advice is to stay away from athletes and celebrities this holiday season.

Ultimately, just remember that these diseases can be serious even though these celebrities should be just fine.