Gillette Children’s is ready to help as the Centers for Disease Control and Prevention (CDC) warns that 2020 could be another peak year for cases of acute flaccid myelitis (AFM)—an uncommon but serious neurological condition that mostly affects children.
The polio-like condition tends to peak in the fall months every other year. The last surge of AFM was in 2018 where more than 200 cases were diagnosed across the U.S., according to the CDC.
Gillette is a center for AFM care
Gillette treated the majority of AFM patients in Minnesota during the last outbreak in 2018. These patients were cared for by several teams of Gillette providers including the pediatric and rehabilitation medicine team, several pediatric neurologists and many rehabilitation therapists.
The brachial plexus team at Gillette is experienced in helping families with one of the serious complications from AFM--a paralysis of a limb or loss of nerve function.
This type of nerve injury due to AFM is similar to a brachial plexus injury, which can occur when nerves become damaged during the birthing process. The brachial plexus is a network of nerves that begins at the spinal cord in the neck and delivers messages from the brain to the shoulder, arm, forearm, wrist and hand.
The Gillette brachial plexus team has decades of experience treating this injury; our team includes a pediatric upper extremity orthopedist, neurosurgeon, rehabilitation medicine specialist, neurologist, and specialized occupational therapists.
Nerve Transfer Surgery Helps
Nerve transfer surgery can help some select patients regain function, and our brachial plexus team has the combined specialties needed to offer this surgery and the subsequent rehabilitation needed to improve upper limb function.
Pediatric orthopedic hand surgeon, Ann Van Heest, MD is Board certified and part of a team of experts at Gillette who can help AFM patients. “I’ve been doing these types of treatments for about 20 years,” Van Heest says.
Nerve transfer surgery involves transferring nearby functioning nerves to the paralyzed nerve, supplying new nerve signals to the damaged area. This surgery can potentially restore function in select patients. The recovery is slow and requires a great deal of therapy post-surgery.
“We have a multi-disciplinary team at Gillette,” Van Heest says. “Before I even talk to a family about nerve transfer surgery our team of Marshall Taniguchi, MD, Peter Kim, MD and Randal Richardson, MD work with me to evaluate the patient.”
Pediatric rehabilitation medicine specialist, Marshall Taniguchi, MD is a key member of the team and helps to outline an individualized treatment plan for each child. Taniguchi is also in the operating room with Van Heest and Kim to help evaluate the nerve as its being harvested and prepared for transfer.
"Go to Gillette"
When Ally Hogan of Woodbury, MN gave birth to her third son, Jack, in May of 2019 she recalls her labor was longer and his birth was more complicated than she’d ever experienced.
“It’s just so weird. He’s our third baby and I thought going into his birth that I was an experienced mom,” Hogan says. “When Jack was born he had bruising on his face and chest and he was breathing on his own. But a doctor in the hospital where Jack was born said he had shoulder dystocia and a team of medical people came running into the delivery room. It was intense.”
Shoulder dystocia is a birth injury that happens when one or both of a baby’s shoulders get stuck inside the mother’s pelvis during delivery. The injury often occurs with no warning. Due to his complicated birth Jack sustained a brachial plexus injury.
“He basically had no movement in his injured arm for four months,” Hogan says. “Right away our regular pediatrician said, ‘Go to Gillette.’ I’m so glad we did.”
Van Heest and other members of the brachial plexus team operated on Jack in March of 2020—right at the beginning of the COVID-19 pandemic. Hogan says she’s grateful for the expert care Jack received and he’s doing well.
“Were so lucky to have Gillette in our backyard,” Hogan says. “The doctors are well-trained. We’re lucky we had Gillette from the beginning.”
Decades of experience and technology means excellent care
“Besides our experienced team, Gillette stands apart from other health care centers because we use an inter-operative EMG,” orthopedic hand surgeon Van Heest says.
The EMG is an electromyogram that use electrodes to track electrical activity within muscles and nerves.
“The most important part of nerve transfer surgery is to know the quality of the nerve you’re transferring and that’s when experience and the EMG can really help,” Van Heest explains. “Once a nerve is transferred patients have that area immobilized for about a month. Then they have six months or more of rehabilitation.”
It’s important for parents to know an AFM outbreak is on the horizon so they can be vigilant and act quickly if their child is showing symptoms of AFM.
Once you see signs of AFM take quick action
The CDC warns AFM can progress rapidly over the course of hours or days and could lead to permanent paralysis and/or life-threatening complications such as respiratory failure.
Gillette health providers and the CDC urge parents who suspect their child might have AFM to get care immediately.
“If a parent notices their child is not walking or moving correctly between now and the end of November they need to immediately contact a health care provider or take their child to an emergency room so they can screen for AFM,” Gillette pediatric rehabilitation medicine specialist, Mark Gormley, MD says. “The faster a child who has AFM is treated the better the outcome for that child.”
Van Heest says about six months from the initial diagnosis and treatment of AFM is the time for parents to consider nerve transfer surgery if their child still has a lack of normal nerve function in their limb.
“It’s important to wait a bit after the first onset of AFM,” Van Heest advises. “In many cases, nerves will return significant function without surgery. Six months after the AFM insult is the most common time for nerve transfer surgery to be done.”
The surgery requires an overnight stay at the hospital and for the area to be immobilized post-operatively. Then intense physical and occupational rehabilitation occur to help the child regain function.
“It’s uplifting and rewarding to be able to provide a child with better neurological function,” Van Heest says. “The nerve transfer surgery is the first part of a long relationship we build with patients and their families.”