Nerve Transfer Surgery is Helping Children with Paralyzing Disease

    A frightening condition causing paralysis in mostly children is being closely investigated by the Centers for Disease Control and Prevention. It’s believed Acute Flaccid Myelitis (AFM) is caused by a common enterovirus that leads to a respiratory infection. In rare cases, the virus attacks the spinal cord affecting the nervous system. Paralysis of the upper and/or lower extremities is among the symptoms.

    That’s what happened to Brandon Noblitt of Greenville, South Carolina.Only 6 years old at the time, Brandon had come down with a cold. A week later, he was unable to move his right arm and leg.

    “One Saturday I woke up and tried to get out of bed but just collapsed,” Brandon said. “I realized something was seriously wrong.”

    Brandon was referred to surgeons at Shriners Hospitals for Children – Philadelphia. They performed nerve transfer surgery to improve function in his arm.

    Nerve transfer procedures involve transferring nearby functioning nerves to the paralyzed area, supplying new nerve signals to the damaged area, potentially restoring function.

    Brandon’s life would change, once again, when a surgeon with Washington University School of Medicine in St. Louis offered hope that Brandon could possibly get out of the wheelchair and walk again.

    “As a peripheral nerve surgeon, I perform nerve transfers all over the body to restore function,” said Moore.  “But my recent focus has been on the lower extremities.

    Moore is an associate professor of surgery at Washington University School of Medicine in St. Louis. She had performed similar nerve transfers in the lower extremities of patients who had suffered injuries from trauma such as car accidents or gunshot wounds.

    AFM was preventing Brandon from standing and walking, so Moore transferred an extra nerve from the area that controls the movement to the toes to the area key to allowing his hip muscle to activate. She also moved extra nerves from his abdomen to his leg so it could once again straighten.

    “There’s a window where function can come back,” said Moore, noting that nerves grow back very slowly – a millimeter a day, an inch a month, and a foot and a half a year. “We hope within 18 months the muscle is moving again.”

    At Brandon’s follow-up visit a year after his surgery, he was no longer in a wheelchair. “Brandon walking is new, and that’s really incredible and a tribute to him, his effort and his family,” Moore said.

    While more than 90% of AFM cases are children, researchers say a child has a one in a million chance of being affected by the disease.

    In 2018, the CDC reported there were 215 confirmed cases of AFM in 40 states. More cases from 2018 are still under investigation, so the number of confirmed cases is expected to rise.

    According to the CDC, “In November 2018, CDC Director Robert R. Redfield, MD, called for the establishment of an Acute Flaccid Myelitis (AFM) Task Force to aid in the ongoing investigation to define the cause of, and improve treatment and outcomes for, patients with AFM. The Task Force functions as a workgroup of the Board of Scientific Counselors, Office of Infectious Diseases.”