Case studies published recently in Pediatric Neurology document two patients, ages 12 and 14, with partial paralysis as the result of acute flaccid myelitis (AFM) who regained movement in their arms after undergoing nerve transfer surgery at Hospital for Special Surgery (HSS).
The procedure was performed by Dr Scott Wolfe, an orthopedic surgeon specializing in nerve injuries at HSS.
“We published the case studies to raise awareness in the medical community,” Wolfe says, in a media release from HSS.
“Since the procedure is so highly specialized and performed by very few surgeons, most people, even doctors, are unaware that nerve transfer could potentially help AFM patients. But there is a window of opportunity, and the surgery should ideally be performed within 6 to 9 months of disease onset.”
Cases of acute flaccid myelitis, which is considered a subtype of transverse myelitis, have been on the rise in the United States since 2014, according to the Centers for Disease Control and Prevention. The illness, which is most common in children and teenagers, appears to occur after a viral infection. Within a day or two, inflammation within the spinal cord leads to muscle weakness and rapid, progressive paralysis of the arms and/or legs. In 2014, and again in 2018, a disturbing spike in cases was reported in certain regions of the United States, explains a media release from Hospital for Special Surgery.
The release describes one patient, 15-year-old Kale Hyder of Davenport, Iowa, who lost function in his hands and was paralyzed from the chest down due to transverse myelitis. Prior to his diagnosis, the 6-foot-2-inch-tall athlete played on his high school’s basketball team.
While receiving occupational therapy at Shriners Hospital for Children in Chicago, Kale and his family were told about Wolfe’s procedure. Although several doctors had indicated that Kale would require assistive devices and a caregiver to help with activities of daily living, Wolfe gave them another option, the release continues.
During the procedure, Wolfe performed nerve transfers to each arm, followed by tendon transfer surgery a year later to restore function in Kale’s hands and enable him to lift his arm over his head.
Nerve transfer surgery entails taking all or part of a working nerve with a less important or redundant function and transferring it to restore function to one or more muscles that have been paralyzed. Performed under a microscope, each set of nerve transfer surgeries can take 5 to 7 hours.
“We have been performing nerve transfers for patients with brachial plexus injuries, so it made sense to try it for AFM patients,” Wolfe shares. “But it’s more challenging. Since the disease causes almost random patterns of muscle paralysis, there’s no roadmap to follow and we have to come up with a creative solution for each patient.”
“We take a full inventory of what’s working and what’s not working in each limb by checking each muscle. We look for donor nerves, so if two muscles move an elbow, for example, we can take one of the nerves controlling that function and use it to restore function to a hand or shoulder,” he adds, in the release.
Kale, now a freshman at Johns Hopkins University, credits Wolfe with enabling him to follow his dreams. A pre-med major, he plans to be a neurologist and a researcher so he can help others. He attends classes, engages in volunteer work on campus, types on a keyboard, shops for food and does his own laundry, the release explains.
“Dr Wolfe has been a role model, and I admire him for the way he works with patients. They have such serious conditions, yet he finds hope in every case and gives his patients hope,” he says. “And he’s a very great problem solver, the way he knows anatomy and physiology. Those problem-solving skills are something that I hope I can have at least half of, one day. It’s crazy what he can do.”
[Source(s): Hospital for Special Surgery, Science Daily]