Functional Improvement of Upper and Lower Extremity After Decompression and Neurolysis and Nerve Transfer in a Pediatric Patient with Acute Flaccid Myelitis

Abstract

Patient: Female, 5 Final Diagnosis: Enterovirus infection Symptoms: Weakness in all 4 limbs Medication: — Clinical Procedure: Nerve decompression • neurolysis and nerve transfer Specialty: Neurosurgery Objective: Rare disease Background: Acute flaccid myelitis is an emerging polio-like illness mostly affecting young children, characterized by rapid onset of extremity weakness and paralysis in 1 or more limbs. Certain viruses, including enteroviruses such as EV-68, EV-71, poliovirus, and West Nile virus, can cause this disorder. The largest known outbreak of EVD68 in the United States was in the summer of 2014, causing severe respiratory illness and acute flaccid myelitis, mainly in young children. Furthermore, the US Centers for Disease Control and Prevention noted an increase in the number of patients with clinical symptoms of acute flaccid myelitis in 2018, and 134 confirmed cases by December 2018 were reported in the USA. Case Report: The patient in our present study was a 5-year-old female who had significant weakness and paralysis in all 4 extremities due to acute flaccid myelitis. EV-D68 had caused this disorder in this patient in August 2014. Conservative management had not helped her condition. Specific areas of concern were both shoulders and biceps, and the femoral and peroneal nerves in both sides. Of these, the right shoulder function was the worst, at less than grade 3. The patient also had marked atrophy and weakness of the right quadricep muscles. The patient underwent surgical treatment and had steady improvements in all 4 extremity functional movements. Conclusions: We demonstrated that decompression, neurolysis, and nerve transfer surgical procedures can be used successfully to correct the paralyzed upper and lower extremity movements in acute flaccid myelitis patients.

Nerve transfers to restore femoral nerve function following oncologic nerve resection

“…Furthermore, wrist flexion is considered synergistic to elbow flexion and improves relearning of the newly reinnervated motor distribution. Since this time, nerve transfers have been described for a multitude of upper and lower extremity deficits, and as we demonstrate in our series, can have important implications for the oncologic limb‐salvage patient 22,24–28 …”

“…Since this time, nerve transfers have been described for a multitude of upper and lower extremity deficits, and as we demonstrate in our series, can have important implications for the oncologic limb-salvage patient. 22,[24][25][26][27][28] Our patients underscore the potential of nerve transfers for func- facilitate re-learning of the transferred function. 16 Furthermore, it is not uncommon in our practice for functional gains to be observed up to 4 years following surgery with the appropriate therapy.…”

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

“…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…”

Acute Flaccid Myelitis: Current Status and Diagnostic Challenges

“…22 Peripheral nerve surgery that prevents muscle atrophy in some AFM patients has offered some optimism and may be an effective treatment. 23 Although the efficacy of most treatments for AFM is still unclear, they may prevent the further progression of the disease. Despite supportive care and rehabilitation, treatments that results in complete recovery from AFM have not yet been implemented.…”