Nerve Transfers for Enterovirus D68-Associated Acute Flaccid Myelitis: A Case Series

Saltzman, Eliana B.; Rancy, Schneider K.; Sneag, Darryl B.; Feinberg, Joseph H.; Lange, Dale J.; Wolfe, Scott W.

doi:10.1016/j.pediatrneurol.2018.07.018

Cited by 38 publications

(37 citation statements)

References 21 publications

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“…Nerve and muscle transfer procedures have been historically used for poliomyelitis associated paralysis [5]. Recently, nerve transfer was shown to improve muscle strength and range of motion in 2 pediatric AFM patients, who sustained upper extremity paralysis [24]. Similarly, another study [27] found that surgery was suitable in EV-D68-induced dysphagia patient; this patient had motor dysfunction but preserved sensory function.…”

Section: Discussionmentioning

confidence: 99%

“…CDC and the experts in this field are working together to understand the long-term outcomes in AFM affected patients. Saltzman et al [24] recently reported functional improvements after nerve transfer in 2 AFM patients. Here, we report the functional improvement of upper and lower extremities, after decompression and neurolysis and nerve transfer in a pediatric patient with acute flaccid myelitis.…”

Section: Introductionmentioning

confidence: 99%

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

Nath

Somasundaram

2019

Am J Case Rep

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Nath

Somasundaram

2019

Am J Case Rep

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“…Surgical procedures such as nerve and muscle transfers have been performed and cases have been described in which improvement of limb function has been achieved. Because over time degeneration of the receiving motor nerves and muscle fibers will occur, evaluation for surgical intervention should be considered early in the disease course [41].…”

Section: Methodsmentioning

confidence: 99%

Acute flaccid myelitis and enterovirus D68: lessons from the past and present

et al. 2019

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Acute flaccid myelitis is characterized by the combination of acute flaccid paralysis and a spinal cord lesion largely restricted to the gray matter on magnetic resonance imaging. The term acute flaccid myelitis was introduced in 2014 after the upsurge of pediatric cases in the USA with enterovirus D68 infection. Since then, an increasing number of cases have been reported worldwide. Whereas the terminology is new, the clinical syndrome has been recognized in the past in association with several other neurotropic viruses such as poliovirus. Conclusion: This review presents the current knowledge on acute flaccid myelitis with respect to the clinical presentation and its differential diagnosis with Guillain-Barré syndrome and acute transverse myelitis. We also discuss the association with enterovirus D68 and the presumed pathophysiological mechanism of this infection causing anterior horn cell damage. Sharing clinical knowledge and insights from basic research is needed to make progress in diagnosis, treatment, and prevention of this new polio-like disease. What is Known: • Acute flaccid myelitis (AFM) is a polio-like condition characterized by rapid progressive asymmetric weakness, together with specific findings on MRI • AFM has been related to different viral agents, but recent outbreaks are predominantly associated with enterovirus D68. What is New: • Improving knowledge on AFM must increase early recognition and adequate diagnostic procedures by clinicians. • The increasing incidence of AFM urges cooperation between pediatricians, neurologists, and microbiologists for the development of treatment and preventive options.

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“…52,53 While the utility of these methods has not been studied extensively in AFM, there are reports suggesting success in individual cases. 54…”

Section: Clinical Outcomesmentioning

confidence: 99%

Acute Flaccid Myelitis: A Clinical Review

Murphy

Pardo

2020

Semin Neurol

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Acute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the spinal cord gray matter on magnetic resonance imaging. In most cases, prodromal fever or respiratory symptoms occur, followed by acute-onset flaccid limb weakness. Respiratory, axial, bulbar, facial, and extraocular muscles may also be affected. The clinical manifestations have been described as “polio-like,” due to striking similarities to cases of poliomyelitis. The primary site of injury in AFM is the anterior horn cells of the spinal cord, resulting in a motor neuronopathy. Seasonal peaks of cases have occurred in the United States every 2 years since 2012. However, AFM remains a rare disease, which can make it challenging for physicians to recognize and differentiate from other causes of acute flaccid paralysis such as Guillain–Barre syndrome, spinal cord stroke, and transverse myelitis. Epidemiological evidence suggests that AFM is linked to a viral etiology, with nonpolio enteroviruses (in particular enterovirus D68) demonstrating a plausible association. The epidemiology, possible etiological factors, clinical features, differential diagnosis, treatment, and outcomes of AFM are discussed in this review.

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Nerve Transfers for Enterovirus D68-Associated Acute Flaccid Myelitis: A Case Series

Cited by 38 publications

References 21 publications

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

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

Acute flaccid myelitis and enterovirus D68: lessons from the past and present

Acute Flaccid Myelitis: A Clinical Review

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