Transverse myelitis and neuralgic amyotrophy

Allan Belzberg, Glendaliz Bosques, Kelly Pham

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Neuralgic amyotrophy (NA), a lower motor neuron (LMN) lesion, presents a flaccid monoplegia of the upper extremity in children. Transverse myelitis (TM) may present with either an LMN or an upper motor neuron (UMN) injury, depending on areas affected on the cord. Both entities are inflammatory and autoimmune in nature. Diagnosis is with MRI and serological studies as well as nerve conduction studies (NCS) and electromyography (EMG). Treatment varies slightly, but includes immunosuppression with steroids, replacement of antibodies with plasmapheresis in addition to intravenous immunoglobulin (IVIG), immunosuppressant, and antineoplastic agents. Further management includes rehabilitation measures with stretching, strengthening, range of motion, neuromuscular electrical stimulation, patient and family education, and equipment evaluation. Children with persistent LMN deficits and limited recovery (6–8 months after onset of disease) may warrant surgical considerations for peripheral nerve surgery. This may include the use of nerve transfers. Secondary surgery, including muscle and tendon transfers, can be considered 1–2 years after disease onset, if persistent residual deficits are present. Most children with NA have good outcomes with resolution of symptoms and improvement in function. Children with TM have a less favorable outcome with one third resolution rate.

Original languageEnglish (US)
Title of host publicationThe Pediatric Upper Extremity
PublisherSpringer New York
Pages711-732
Number of pages22
ISBN (Electronic)9781461485155
ISBN (Print)9781461485131
DOIs
StatePublished - Jan 1 2015

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Belzberg, A., Bosques, G., & Pham, K. (2015). Transverse myelitis and neuralgic amyotrophy. In The Pediatric Upper Extremity (pp. 711-732). Springer New York. https://doi.org/10.1007/978-1-4614-8515-5_32