Nerve transfers for acute flaccid myelitis: a case series

Heise, Carlos Otto; Oliveira, Adilson de; Bhering, T; Martins, Roberto S.; Sterman-Neto, Hugo; Foroni, Luciano; Siqueira, Mário G.

doi:10.1007/s00381-020-04773-6

Cited by 9 publications

(19 citation statements)

References 18 publications

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“…When multiple limbs are involved, weakness tends to be asymmetric. 18,23,36,52,58 Weakness of proximal extremity muscles tends to be greater than distal muscles, both at initial presentation 5,18,30,59,63,75 and at long-term follow-up. 4–7 Many patients also report cranial nerve involvement and neck/trunk weakness.…”

Section: Resultsmentioning

confidence: 99%

“…4,13,35,39,43,54,60,64,66,89 Unfortunately, however, most studies also demonstrate that many patients have persistent deficits in strength and function despite therapy. 4,7,13,30,35,39,43,54,66,75…”

Section: Resultsmentioning

confidence: 99%

“…After removal of duplicates and initial screening, 500 were reviewed and assessed for eligibility. After application of inclusion and exclusion criteria, 99 articles were included in this study (55 case reports/series, 1,4–7,9–57 33 retrospective cohort studies, 2,3,58–88 seven cross-sectional studies, 89–95 and four case-control studies 96–99 ) (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…89 Patients and families should be counseled preoperatively that distal nerve transfers have a tendency to recover more function than proximal nerve transfers, likely related to the greater severity of proximal limb weakness seen in AFM in general. 6,30,45,59,68 The challenges of performing nerve transfers in patients with AFM include patient selection, donor nerve selection, and timing of the procedure. 6 Patients often have defects that span large segments of spinal cord gray matter, which can make it difficult to find unaffected donor nerves.…”

Section: Recommendationsmentioning

confidence: 99%

“…6,45 Although studies are limited, the early literature provides compelling evidence that nerve transfers are beneficial for patients with persistent weakness secondary to AFM. 6,19,30,45,59,64,[66][67][68] Although not all patients experienced significant improvement in all muscle groups, 72.1% of patients analyzed in this review had improvement in at least one muscle group after nerve transfer surgery, with many patients experiencing significant improvement (Table 1). In addition, in one study that used social media surveys, 75% of parents of patients with AFM reported subjective recovery after nerve transfers, and 100% of them would recommend the procedure.…”

Section: Recommendationsmentioning

confidence: 99%

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Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Kozlowski¹,

Linzey

Muhlestein

et al. 2022

Plastic &Amp; Reconstructive Surgery

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cute flaccid myelitis (AFM) is a polio-like illness in children that causes inflammation of the spinal cord gray matter. AFM is characterized by a viral prodrome that is followed by mild to severe weakness in one to four limbs that can be persistent even after conservative management. 1 Almost one-third of patients admitted to the hospital require intubation because of weakness of respiratory muscles or bulbar muscle weakness. 2 AFM was initially recognized after the first major outbreak in the United States in 2014.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

See 3 more Smart Citations

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Kozlowski¹,

Linzey

Muhlestein

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Selective nerve transfers to restore shoulder abduction and flexion in acute flaccid myelitis: A case report

Liu,

Massenburg,

Otten

et al. 2023

Microsurgery

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Acute flaccid myelitis (AFM) is a polio‐like condition predominantly affecting children that is characterized by acute‐onset, asymmetric flaccid paralysis, often preceded by a prodromal fever or viral illness. With prompt diagnosis and early surgical referral, nerve transfers may be performed to improve function. Highly selective nerve transfers are ideal to preserve existing functions while targeting specific deficits. In this report, we present a case of a double fascicular nerve transfer of median and ulnar nerve fascicles to the axillary nerve, combined with selective transfer of the spinal accessory nerve to the supraspinatus branch of the suprascapular nerve, performed for a 5‐year‐old girl who developed AFM after an upper respiratory infection. Six months after the onset of the patient's symptoms, the patient had continued weakness of shoulder flexion and abduction, atrophy of the deltoid, and supraspinatus muscles, though needle electromyography revealed a functioning infraspinatus muscle. The patient had no post‐operative complications and at 2 years of postoperative follow up achieved shoulder abduction and flexion Active Movement Scale scores of 7/7 compared to preoperative scores of 2/7, with no loss of function in the donor nerve domains. The patient showed active shoulder abduction against gravity to 90° from 30° preoperatively and shoulder flexion to 180° from 15° preoperatively. This case report shows that highly selective nerve transfers may preserve existing functions while targeting specific deficits. A double fascicular transfer from the median and ulnar nerves to axillary nerve may provide abundant axons for functional recovery.

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Upper extremity nerve transfers for acute flaccid myelitis: a systematic literature review

et al. 2022

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Nerve transfers for acute flaccid myelitis: a case series

Cited by 9 publications

References 18 publications

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

Selective nerve transfers to restore shoulder abduction and flexion in acute flaccid myelitis: A case report

Upper extremity nerve transfers for acute flaccid myelitis: a systematic literature review

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