Emerging concepts in the pathophysiology of recovery from neonatal brachial plexus injury

Can peripheral trauma induce dystonia and other movement disorders? Yes!

“…Using transcranial magnetic stimulation, Byrnes et al58 noted a distortion and a displacement of corticomotor map in patients with dystonia writer's cramp, and this map was temporarily altered following botulinum toxin injection. There are many other studies that provide evidence for central reorganization following peripheral injury 47, 53, 59–61, 61A, 61B. The mechanisms by which altered peripheral input can produce central effects are poorly understood, but some of these peripherally induced central changes may be mediated by retrograde axonal transport of trophic factors, such as the ciliary neurotrophic factor 62.…”

Our experience with surgical treatment of perinatal brachial plexus palsy – results in different types of lesions

“…W wa runkach pra wi dło wych w ko lej nych mie sią cach ży cia dziec ka pry mi tyw ne, nie efek tyw ne ru chy koń czy ny za mie nia ne są na pre cy zyj ne ru chy kie ro wa ne wzrokiem. Po ra że nie koń czy ny gór nej w tym istot nym okre sie roz wo ju po wo du je, że ru cho we re jo ny mó zgu nie wy twa rza ją pra wi dło we go pro gra mu ru cho we go dla uszko dzo nej koń czy ny [8,24]. Wpływ ma tu nie tyl ko brak ru chów koń czy ny, ale i utra ta bodź ców czucio wych z mię śni, sta wów i skó ry [8].…”

“…In normal conditions, in the following months of child's life, primitive and ineffective limb movements are gradually replaced with precise sight-controlled movements. If the limb is paralysed at this critical period in a child's development, the motor areas of the brain do not create the normal motor patterns for the affected limb [8,24], which is the result not only of lack of motion, but also loss of sensory stimuli from the muscles, joints and skin [8]. Impaired motor function of the upper limb can also be caused by co-contraction [9,25].…”

A Funhouse Mirror: Muscular Co-Contractions as a Reflection of a Spontaneous Aberrant Regeneration of the Brachial Plexus Injury in the Adults - Anatomical Background, an Attempt to Classify and Their Clinical Relevance within the Reconstruction Strategie

“…The dynamics of spontaneous regeneration are well described in newborns with obstetric BPI [4,5]. It is often accompanied by co-contractions (Co-C) of de novo reinnervated muscles [6], which respond well to injections of botulinum toxin A [7].…”