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Published in: Child's Nervous System 1/2021

01-01-2021 | Polio Virus | Original Article

Nerve transfers for acute flaccid myelitis: a case series

Authors: C. O. Heise, A. J. de Oliveira, T. Bhering, R. S. Martins, H. Sterman-Neto, L. Foroni, M. G. Siqueira

Published in: Child's Nervous System | Issue 1/2021

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Abstract

Background

Acute flaccid myelitis (AFM) syndrome consists of loss of lower motor neurons following a viral infection, with preserved sensory function. It usually affects the upper limbs asymmetrically, with proximal more than distal muscle involvement.

Methods

Five cases were surgically treated with nerve transfers: spinal accessory to suprascapular nerve transfer (4 patients), branch of radial nerve to axillary nerve transfer (Somsak’s procedure) (2 patients), and transfer of a fascicle of the ulnar nerve to the motor branch to the biceps (Oberlin’s procedure) (1 patient).

Results

Motor improvement was seen in three cases. Widespread motor involvement was associated with poor outcome.

Conclusion

This small series of cases reinforces that nerve transfers are a reliable option for treatment of selected children with AFM.
Literature
1.
go back to reference Ayers T, Lopez A, Lee A, Kambhampati A, Nix WA, Henderson E, Rogers S, Weldon WC, Oberste MS, Sejvar J, Hopkins SE, Pallansch MA, Routh JA, Patel M (2019) Acute flaccid myelitis in United States: 2015-2017. Pediatrics 144(5):e20191619PubMedCrossRef Ayers T, Lopez A, Lee A, Kambhampati A, Nix WA, Henderson E, Rogers S, Weldon WC, Oberste MS, Sejvar J, Hopkins SE, Pallansch MA, Routh JA, Patel M (2019) Acute flaccid myelitis in United States: 2015-2017. Pediatrics 144(5):e20191619PubMedCrossRef
2.
go back to reference Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, Dominguez SR (2016) Acute flaccid myelitis: a clinical review of US cases 2012-2015. Ann Neurol 80(3):326–338PubMedPubMedCentralCrossRef Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, Dominguez SR (2016) Acute flaccid myelitis: a clinical review of US cases 2012-2015. Ann Neurol 80(3):326–338PubMedPubMedCentralCrossRef
3.
go back to reference Helfferich J, Knoester M, Van Leer-Buter CC, Neuteboom RF, Meiners LC, Niesters HG, Brouwer OF (2019). Acute flaccid myelitis and enterovirus D68: lessons from the past and present. Eur J Pediatr 178(9): 1305–1315 Helfferich J, Knoester M, Van Leer-Buter CC, Neuteboom RF, Meiners LC, Niesters HG, Brouwer OF (2019). Acute flaccid myelitis and enterovirus D68: lessons from the past and present. Eur J Pediatr 178(9): 1305–1315
5.
go back to reference Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF, Niesters HGM (2019). Twenty-nine cases of enterovirus-D68-associated acute flaccid myelitis in Europe 2016: a case series and epidemiologic overview. Pediatr Infect Dis J 38(1): 16–21 Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF, Niesters HGM (2019). Twenty-nine cases of enterovirus-D68-associated acute flaccid myelitis in Europe 2016: a case series and epidemiologic overview. Pediatr Infect Dis J 38(1): 16–21
6.
go back to reference Van Haren K, Ayscue P, Waubant E, Clayton A, Sheriff H, Yagi S, Glenn-Finer R, Padilla T, Strober JB, Aldrovandi G, Wadford DA, Chiu CY, Xia D, Harriman K, Watt JP, Glaser CA (2015) Acute flaccid myelitis of unknown etiology in California, 2012-2015. JAMA 314(24):2663–2671PubMedCrossRef Van Haren K, Ayscue P, Waubant E, Clayton A, Sheriff H, Yagi S, Glenn-Finer R, Padilla T, Strober JB, Aldrovandi G, Wadford DA, Chiu CY, Xia D, Harriman K, Watt JP, Glaser CA (2015) Acute flaccid myelitis of unknown etiology in California, 2012-2015. JAMA 314(24):2663–2671PubMedCrossRef
7.
go back to reference Hopkins SE, Elrick MJ, Messacar K (2019) Acute flaccid myelitis - keys to diagnosis, questions about treatment, and future directions. JAMA Pediatr 173(2):117–118PubMedCrossRef Hopkins SE, Elrick MJ, Messacar K (2019) Acute flaccid myelitis - keys to diagnosis, questions about treatment, and future directions. JAMA Pediatr 173(2):117–118PubMedCrossRef
8.
go back to reference Martin JA, Messacar K, Yang ML, Maloney JA, Lindwall J, Carry T, Kenyon P, Sillau SH, Oleszek J, Tyler KL, Dominguez SR, Schreiner TL (2017) Outcomes of Colorado children with acute flaccid myelitis at 1 year. Neurology 89(2):129–137PubMedPubMedCentralCrossRef Martin JA, Messacar K, Yang ML, Maloney JA, Lindwall J, Carry T, Kenyon P, Sillau SH, Oleszek J, Tyler KL, Dominguez SR, Schreiner TL (2017) Outcomes of Colorado children with acute flaccid myelitis at 1 year. Neurology 89(2):129–137PubMedPubMedCentralCrossRef
9.
go back to reference Kirolos A, Mark K, Shetty J, Chinchankar N, Mcdougall C, Eunson P, Stevenson J, Templeton K, Lothian NHS (2019) Outcome of paediatric acute flaccid myelitis associated with enterovirus D68: a case series. Dev Med Child Neurol 61(3):376–380PubMedCrossRef Kirolos A, Mark K, Shetty J, Chinchankar N, Mcdougall C, Eunson P, Stevenson J, Templeton K, Lothian NHS (2019) Outcome of paediatric acute flaccid myelitis associated with enterovirus D68: a case series. Dev Med Child Neurol 61(3):376–380PubMedCrossRef
10.
go back to reference Liao HT, Chuang DC, Ulusal AE, Schrag C (2007) Surgical strategies for brachial plexus polio-like paralysis. Plast Reconstr Surg 120(2):482–493PubMedCrossRef Liao HT, Chuang DC, Ulusal AE, Schrag C (2007) Surgical strategies for brachial plexus polio-like paralysis. Plast Reconstr Surg 120(2):482–493PubMedCrossRef
11.
go back to reference Dorsi MJ, Belzberg AJ (2012) Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: case report. Microsurgery 32(1):64–67PubMedCrossRef Dorsi MJ, Belzberg AJ (2012) Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: case report. Microsurgery 32(1):64–67PubMedCrossRef
12.
go back to reference Ochiai N, Matsumoto Y, Hara Y, Nishiura Y, Murai S (2019) For how long do denervated muscles in children retain the ability to regenerate? Restoration of elbow flexion and shoulder function by partial nerve transfer in a child with long-standing poliomyelitis-like paralysis. J Orthop Sci 24(2):195–199PubMedCrossRef Ochiai N, Matsumoto Y, Hara Y, Nishiura Y, Murai S (2019) For how long do denervated muscles in children retain the ability to regenerate? Restoration of elbow flexion and shoulder function by partial nerve transfer in a child with long-standing poliomyelitis-like paralysis. J Orthop Sci 24(2):195–199PubMedCrossRef
13.
go back to reference Saltzman EB, Rancy SK, Sneag DB, Feinberg Md JH, Lange DJ, Wolfe SW (2018) Nerve transfers for enterovirus D68-associated acute flaccid myelitis: a case series. Pediatr Neurol 88:25–30PubMedCrossRef Saltzman EB, Rancy SK, Sneag DB, Feinberg Md JH, Lange DJ, Wolfe SW (2018) Nerve transfers for enterovirus D68-associated acute flaccid myelitis: a case series. Pediatr Neurol 88:25–30PubMedCrossRef
14.
go back to reference Doi K, Sem SH, Hattori Y, Sakamoto S, Hayashi K, De la Red-Gallego MA (2019) Surgical reconstruction for upper-extremity paralysis following acute flaccid myelitis. JB JS Open Access 4(4):e0030PubMedPubMedCentralCrossRef Doi K, Sem SH, Hattori Y, Sakamoto S, Hayashi K, De la Red-Gallego MA (2019) Surgical reconstruction for upper-extremity paralysis following acute flaccid myelitis. JB JS Open Access 4(4):e0030PubMedPubMedCentralCrossRef
15.
go back to reference Pino PA, Intravia J, Kozin SH, Zlotolow DA (2019) Early results of nerve transfers for restoring function in severe cases of acute flaccid myelitis. Ann Neurol 86(4):607–615PubMedCrossRef Pino PA, Intravia J, Kozin SH, Zlotolow DA (2019) Early results of nerve transfers for restoring function in severe cases of acute flaccid myelitis. Ann Neurol 86(4):607–615PubMedCrossRef
16.
go back to reference Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am. 28(4):633–638PubMedCrossRef Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (2003) Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am. 28(4):633–638PubMedCrossRef
17.
go back to reference Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ (1994) Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am 19(2):232–237PubMedCrossRef Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ (1994) Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am 19(2):232–237PubMedCrossRef
18.
go back to reference Wiechers DO (1988) New concepts of the reinnervated motor unit revealed by vaccine-associated poliomyelitis. Muscle Nerve 11:356–364PubMedCrossRef Wiechers DO (1988) New concepts of the reinnervated motor unit revealed by vaccine-associated poliomyelitis. Muscle Nerve 11:356–364PubMedCrossRef
19.
go back to reference Yuen TS, Olney RK (1991) AAEM case report #23: acute paralytic poliomyelitis. Muscle Nerve 14:1159–1164CrossRef Yuen TS, Olney RK (1991) AAEM case report #23: acute paralytic poliomyelitis. Muscle Nerve 14:1159–1164CrossRef
Metadata
Title
Nerve transfers for acute flaccid myelitis: a case series
Authors
C. O. Heise
A. J. de Oliveira
T. Bhering
R. S. Martins
H. Sterman-Neto
L. Foroni
M. G. Siqueira
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 1/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04773-6

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