Medical Experts

Hi Kay: This is one of the commonest questions we get asked and there is no simple answer. It is always important to weigh risk against benefits for any medical treatment and vaccinations are no exception. We know that the risk of getting GBS again after receiving any vaccination is extremely small. Without knowing the specifics of your travel I am unable to say for certain what risk you face of getting typhoid, yellow fever, etc. If you are mainly in cities with only brief forays into the countryside it is unlikely that you will be exposed to any of these diseases. If you are to spend significant time in mosquito-infested areas then yellow fever vaccination would be important. Unless you are going to be in an area rife with feral dogs I would avoid rabies vaccination since that can trigger GBS is produced in neural tissue as it often is in developing countries. I strongly recommend that you consult with an expert in travel medicine to help you determine just what vaccinations are highly recommended, based on your specific travel plans, and what can be safely be omitted. In the final analysis, your risk of getting GBS again is extremely small, regardless of which vaccinations you get.

There is insufficient information here for me to be able to comment. There is no mention of GBS, CIDP or any related condition.

Hmm! This is a bit odd. It is possible that it is unrelated. For example, if she is diabetic this new problem could be related to diabetes. However, when 2 neurological problems occur close to each other temporally one doesn’t like to invoke an unrelated condition. The 2nd possibility is that she has CIDP rather than GBS and that this 6th nerve palsy represents her first relapse of what is going to be a chronic condition. However, cranial nerves are rarely affected in CIDP. The 3rd possibility is that she has a very rare condition called CANOMAD which can present initially looking very much like GBS but then relapses. In CANOMAD damage to the ocular nerves is common, that is what the “O” stands for. There is a specific antibody test that can be done to look for that; it has to be sent overseas but it is certainly worth considering that possibility. Regardless of which of these it is you need to get back to see a neurologist. There is simply not enough information for me to be able to tell what is going on. If it is an unrelated condition there is not much to worry about because almost all 6th nerve palsies get better but if it is CIDP or CANOMAD the condition will need specific and probably long term treatment. Please take this information to your GP and get a referral to a neurologist, hopefully the one who saw you for the initial GBS.

I suggest you try to get an appointment with Dean Kilfoyle. If you are a former patient of Dr Willoughby I don’t think you need to go through your GP. Just call the Neurology Department and tell them you were a patient of Willoughby and your CIDP is relapsing and ask for an appointment with Kilfoyle.

Hi Mandy: All sounds pretty scary for you. I am not sure what is going on but I can say with confidence that it is not GBS. The cardinal manifestation of GBS is paralysis. While some of your symptoms such as pain can occur with GBS it would not occur in the absence of paralysis. There are a number of infections that are spread by mosquito bites such as dengue, zika and others which are extremely unpleasant and can cause many of the symptoms that you describe but are ultimately benign in the vast majority of people affected. I wonder if that might be what you have experienced. I urge you to talk to your doctor about it. It is impossible for me to make a confident diagnosis without seeing you. Gareth