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Nerve Transfers for Treatment of Upper Extremity Paralysis in Acute Flaccid Myelitis
Rakel M. Zarb, MD1; Rachel Cohen-Shohet, MD2; Patrick C Hettinger, MD3; Milan Patel, BS
1Medical College of Wisconsin, Milwaukee, WI; 2Medical College of Wisconsin, Wauwatosa, WI; 3Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI; 4Medical College of WI, Wauwatosa, WI

Background: Acute flaccid myelitis (AFM) is a rare but debilitating neurologic disease that affects the gray matter of the spinal cord and results in pure motor deficits in school-aged children. Unfortunately, 90% of patients do not experience complete spontaneous recovery, and medical therapy has not proven efficacious. Herein we report the course of two patients with AFM who underwent upper extremity nerve transfers and had improvement in function.
Methods: Patient 1 was a 9-year-old male who developed left upper extremity paralysis after viral prodrome. Patient 2 was a 2-year-old female with left upper extremity and right lower extremity paralysis. She received IV immunoglobulin and had significant improvement, but persistent shoulder weakness. Patients 1 and 2 underwent nerve transfers 7 and 6 months after onset of weakness, respectively (Tables 1 & 2).
Results: Both patients experienced significant improvement in muscle strength (Table 1) and ability to complete activities of daily living (ADLs). Patient 1 had final follow-up two years post-operatively; patient 2 had final follow-up at 1 year (Figure 1).
Conclusions: AFM often results in lasting deficits, which may have a devastating impact on motor development in children. Nerve transfers in the upper extremity within one year of symptom onset appears to be beneficial.



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