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Pediatr Neurol. 2018 Nov;88:25-30. doi: 10.1016/j.pediatrneurol.2018.07.018. Epub 2018 Aug 20.

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

Author information

1
Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York.
2
Department of Radiology, Hospital for Special Surgery, New York, New York.
3
Department of Neurology, Hospital for Special Surgery, New York, New York; Weill Medical College of Cornell University, New York, New York; New York-Presbyterian Hospital, New York, New York.
4
Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, New York; Weill Medical College of Cornell University, New York, New York; New York-Presbyterian Hospital, New York, New York. Electronic address: wolfes@hss.edu.

Abstract

BACKGROUND:

Acute flaccid myelitis is associated with enterovirus D68 -induced inflammation and destruction of cervical anterior horn cells. To date, no medical intervention has altered the disease course.

METHODS:

We report two pediatric patients who were treated with nerve transfer in three limbs with sustained upper extremity neuropathy. Postoperative outcomes included muscle strength, graded on the British Medical Research Council (BMRC) scale, range of motion, and electromyography.

RESULTS:

Two years postoperatively, Patient 1 had improved elbow flexion to BMRC grade 4+, 125° of flexion, and discrete to decreased motor unit recruitment in targeted muscles. Twenty-one months postoperatively, Patient 2 demonstrated right brachialis flexion to BMRC grade 4+/5 and deltoid firing with simultaneous pectoralis major recruitment, and limited but active flexor digitorum profundus flexion.

CONCLUSIONS:

Both patients continue to demonstrate functional recovery two years postoperatively. These outcomes suggest a promising reconstructive technique for this emerging and devastating viral endemic.

KEYWORDS:

Acute flaccid myelitis; Acute flaccid paralysis; EV68; Enterovirus; Nerve transfers; Pediatrics

[Indexed for MEDLINE]

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