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

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


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.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • Child
  • Electromyography
  • Enterovirus D, Human / pathogenicity*
  • Enterovirus Infections / complications*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Myelitis / diagnostic imaging
  • Myelitis / etiology*
  • Myelitis / surgery*
  • Myelitis / virology*
  • Nerve Transfer / methods*
  • Paraplegia / etiology
  • Paraplegia / surgery
  • Retrospective Studies
  • Spinal Cord / diagnostic imaging