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This Nerve Transfer Can Potentially Restore Function in Stroke Victims

December 22, 2017

While this nerve transfer technique has been quite controversial, it has been found to help treat spastic hemiplegia in the arm and hand. Hemiplegia is the paralysis caused by strokes and conditions such as cerebral palsy. According to estimates, 30-60 percent of stroke survivors suffer from spastic limb hemiplegia.

Mou-Xiong Zheng, MD, PhD, a hand surgeon in Shanghai, China said, “Transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in the function and reduction of spasticity than rehabilitation alone over a period of 12 months.” He also stated that there was a physiological connectivity that had developed between the paralyzed hand and the ipsilateral cerebral hemisphere.

On the contrary, not everyone was thrilled to embrace this new discovery. Robert Spinner, MD, an orthopedic surgeon and orthopedic surgeon with the Mayo Clinic, said these results were “exciting” but had further questions about the “connectivity”that occurred and whether it was a direct result of the procedure. His doubts remain in the time frame of the discovery, he said, “that distal muscles are functionally reinnervated in such a short time seems unlikely to us.” Spinner and his colleagues also wrote, “An alternative hypothesis to explain the functional improvement is that there was a reduction in limb spasticity and improved function through the normal motor pathways of the C5, C6, C8 and T1 nerves, and the effect may have been augmented by rehabilitation.” They went on to explain that since nerves do not regenerate that quickly, fully or consistently, an improvement in function in 10 short months cannot be eagerly explained as being a predominant result of the contralateral nerve transfer.

Zheng and his colleagues did say that conducting a larger, more extensive study might help shed some more light on their initial finding. They said it would help “determine whether cervical nerve transfer results in safe, consistent and long-term improvements in the function of an arm that is chronically paralyzed as a result of a cerebral lesion.”

Zheng and his colleagues have been studying 36 spastic hemiplegia patients between the ages of 12-45 years old for approximately five years. Power and sensitivity had decreased, yet remained active, in the affected hand. Half of these patients underwent C7 nerve transfer plus rehabilitation, and half underwent only rehabilitation. If a patient had systemic diseases such as diabetes mellitus or cardiopulmonary disease, developmental delay or sever deformities, they were excluded.

After analyzing MRI tests, the mean changes in the Fugl-Meyer Assessment scores from baseline to 12 months were 17.7±5.6 in the surgery group and 2.6±2.0 in the control group, indicating significant improvement in the surgery group. A significant amount of improvements in spasticity had been seen from baseline to 12 months in all relevant joints with surgery. This includes elbow extension, forearm rotation, wrist extension, thumb extension and the extension of fingers two through five.

At 12 months, 16 of the 18 patients that had received surgery on their affected hand were able to perform three or more basic tasks. In the control group, seven of the 18 patients could perform two tasks, three could perform one, and eight could perform none.

Zheng and his colleagues wrote that, “The paralyzed arm showed improper power, function and reduced spasticity at month 12 in the surgery group, whereas there was significantly less improvement in the control group, in which patients received only physical therapy.”

https://www.medpagetoday.com/neurology/generalneurology/70030