Rare flu side effect temporarily paralyzes Illinois boy, 5

INDIANAPOLIS (AP) - The first sign came during a basketball game. Five-year-old Brysen Mills, normally an energetic cheerleader for his older brother's team, lay quietly on a bed of coats stacked on the bleachers and complained that his legs hurt.

He continued to complain of pain the following day and stayed home from school. His mother, Lesley, chalked his discomfort up to growing pains or perhaps overdoing it while playing in the snow a few days earlier.

Then the following day, when he woke up, he could not walk at all.

His mother carried him to the car and drove straight from the family's home in Paris, Illinois, to the pediatrician's office in Terre Haute. His condition brought back painful memories of her mother, who had died of ALS five years earlier.

Brysen's pediatrician was baffled as to what could be causing the paralysis. The doctor consulted with a colleague, who suggested meningitis.

Two and a half years ago doctors had started monitoring a low-grade tumor they had found in Brysen's brain, so they also feared that his condition could be related to that.

An ambulance ferried Brysen to the emergency room at Riley Hospital for Children, where doctors struggled to determine the cause.

MRIs of his brain and spine shed no light on the mystery. Nor did X-rays of his hip.

For four days, doctors pondered what lay behind his symptoms.

Could it be meningitis? Viral encephalitis? One neurologist suggested Guillain-Barré Syndrome, a rare neurological condition in which the body's immune system attacks its nerves. Sometimes this complication occurs in the weeks following a viral infection, such as the flu.

Had Brysen recently been sick?

Indeed, he had.

At the beginning of December, Brysen was diagnosed with flu. A few weeks later he had a stomach bug.

But Brysen's MRI had appeared normal. Usually when Guillain-Barré hits, a spinal MRI shows signs that some damage has occurred to the roots of the spinal cord.

Meanwhile, Brysen continued to deteriorate. The pain had not abated, and the paralysis was creeping up his body.

The once lively boy with an active imagination and a love of the Power Rangers spent most of the day curled in a fetal position in his hospital bed.

His father, Josh Mills, was deployed in the Middle East and agonized over being half a world away. He received approval to end his deployment a few days early and fly home.

By the time he arrived, Brysen couldn't even roll from one side to the other, though he did recognize his father.

Eventually, despite the normal MRI, doctors recommended that Brysen undergo another test for Guillain-Barré, an electromyogram or nerve function test. That test convinced the doctors that Brysen had Guillain-Barré, said Dr. Deborah Sokol, a pediatric neurologist at Riley Hospital for Children.

Doctors don't know what triggers Guillain-Barré Syndrome, but they know the autoimmune condition develops when an antibody geared up to fight an infection goes awry and targets the body's spinal cord and peripheral nerves instead of the intruder.

Overall, the condition is rare, with only about one in 100,000 people developing it each year, according to the National Institute of Neurological Disorders and Stroke. While it is more common in older adults, when it does occur in children, it's most likely to cause pain and lead to difficulty walking.

Doctors know to look for it as a cause if a person develops symptoms after recovering from the flu.

"What we know is that when there's flu season, you can be sure we are going to see more cases of Guillain-Barré," Sokol said.

While this year has been a comparatively mild flu season, Indiana has seen 41 flu-related deaths, most of them in adults over age 50. Last week, however, saw the state's first pediatric flu-related death, according to the Indiana State Department of Health.

Flu vaccine also may increase a person's risk of developing this condition, albeit by only a minuscule amount, according to the Centers for Disease Control and Prevention. While it's unclear such a link exists, if it does, it's only one to two additional cases per million doses of flu vaccine, federal health officials say.

Each year Riley Hospital for Children sees about 10 cases of Guillain-Barré, Sokol said.

Few are as severe as Brysen's, she said. Usually Guillain-Barré affects only the covering, or myelin, of the nerve. In Brysen's case, the axon, part of the nerve itself, was also damaged.

There's no immediate cure for the syndrome, and it often resolves on its own. Symptoms can last for a week to several years, according to the CDC. Some people will have permanent nerve damage, and an estimated 3 to 5 percent of people will die of complications related to the paralysis, according to the World Health Organization.

Immunoglobulin therapy, which provides the body with extra healthy antibodies, is thought to reduce the severity of symptoms and lead to a faster recovery.

Doctors started Brysen on the intravenous treatment and transferred him to the intensive care unit to monitor him even more closely.

"The weakness (of Guillain-Barré Syndrome) is usually ascending, and there's a window of time when that's especially critical. And that can cause you to stop breathing, and Brysen was very close to that," Sokol said.

By Feb. 1, doctors feared Brysen might have to go on the ventilator at some point in the next 24 hours.

The next morning, however, Brysen had clearly rallied for the first time.

"He was more awake. He wanted his iPad; that was a big thing," Lesley said. "He wanted toys to play with, so we could tell he was feeling more himself."

Slowly, Brysen started to heal, to try to regain strength. During his hospitalization he had lost 8 pounds off his 44-pound frame, and his muscle tone had disappeared.

On the first day Brysen was in rehabilitation, therapists had him try to walk with a walker, Josh recalled.

"His legs just folded beneath him," he said.

Within a few days, though, he was able to take a few steps.

"It was almost like a light switch going on," Josh said.

About two weeks later, Brysen was ready to return home, back to his two brothers, ages 9 and 15, and head back to kindergarten, though he likes to tells strangers he is in first grade. It may take him a few more weeks to get back to recess though, as he returns to full strength. With time, Brysen is expected to make a complete recovery.

While he remains weak and somewhat clumsy, he is rapidly returning to normal. He is supposed to use a walker, lest he fall on weakened muscles. But he often forgets and bounces off without it before his mother or father reminds him to be careful.

On the morning of his discharge, Brysen donned an orange shirt that depicted Mickey Mouse playing basketball, which bore the phrase #BrysenStrong. In solidarity, his brother's team had had the shirts made to wear for practice while Brysen had languished in the hospital.

With his walker by his side, Brysen sat happily playing with cars, keeping up a steady patter.

"He's a sound effects kind of kid," his father said.

Then Brysen paused from his cars to ask eagerly if it was time for him "to ring the bell," signifying his hospital stay had come to an end.

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Source: The Indianapolis Star

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Information from: The Indianapolis Star, http://www.indystar.com