At Brandon Noblitt’s first appointment with Washington University surgeon Amy Moore, MD, a year ago, he was barely able to walk, mostly using a wheelchair to get around. 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 collaps,” Brandon says. “I realized something is seriously wrong.” Brandon is diagnose with a rare yet frightening disease known as acute flaccid myelitis that is causing paralysis in children around the country.
Researchers believe the condition may be cause by a common enterovirus that leads to a respiratory infection. In some cases, the virus also may attack the spinal cord, paralyzing the upper and/or lower extremities and possibly even compromising a child’s ability to breathe.
In 2018, there are 201 confirm cases in the U.S., according to the Centers for Disease Control and Prevention. Thankfully, a child still only has a one in a million chance of being affecting. Brandon, who lives in Greenville, S.C., is referre to surgeons at Shriners Hospitals for Children Philadelphia. They perform nerve transfer surgery to improve function in his arm.
The procedure involves transferring nearby functioning nerves to the paralyzed area, supplying new nerve signals to the damaged area; potentially restoring function. Recovery is slow and requires a significant amount of physical therapy. For his leg, though, Shriner’s doctors referred Brandon to Moore, an associate professor of surgery at Washington University School of Medicine in St. Louis. She and colleague Thomas Tung, MD, a professor of surgery, had been performing similar nerve transfers in the lower extremities of patients who is suffere injuries from trauma such as car accidents or gunshot wounds.
Expertise with nerve
As a peripheral nerve surgeon, I perform nerve transfers all over the body to restore function;” Moore said. “But my recent focus has been on the lower extremities. because “My colleagues in Philadelphia is treating patients with AFM for the upper extremities and thought of me and my expertise with nerve transfers in the lower extremities as someone who help these patients restore function.”
Moore, who works in the Division of Plastic and Reconstructive Surgery; now has performed nerve transfer surgery on 12 children affected by AFM. She and Tung performed the procedure on Brandon to stabilize his hip. AFM was preventing him from standing and walking, so Moore transfer 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. because “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.”