Experimental Procedure 'Rewires' 6-Year-Old's Nervous System
Boy's paralysis may be reversible with new rerouting surgery.
March 29, 2010— -- Six-year-old Alex McShane of Phoenixville, Pa. lost the use of his right arm six months ago. But thanks to an experimental surgical procedure that effectively rewired the nerves in his arm, the paralysis may be reversible.
During a five-hour surgery Tuesday morning, doctors harvested functioning nerve tissue from Alex's leg and used it as a graft to reroute a nerve in his shoulder to instead control his right arm.
If his recovery goes as planned, Alex will be able to "bend his arm with a different nerve than he was born with," said the boy's surgeon, Dr. Allan Belzberg, an associate professor of neurosurgery at the Johns Hopkins University School of Medicine in Baltimore.
"We plugged the graft into the nerve that bends your elbow so when he thinks 'shrug my shoulder,' his arm will bend," Belzberg said. "Over time, because he's so young, his movement will smooth out as he relearns [how to use his arm]."
Alex's arm was paralyzed in the fall after he was stricken with transverse myelitis, a rare auto-immune disease in which the immune system attacks and damages the nerves of the spinal cord.
After what was thought to be a bout of strep throat in September turned out to be the beginning stages of transverse myelitis, Alex's right arm went slack, followed by his neck, left arm and leg, and his diaphragm.
"We took him to the ER on Sept. 26, and we haven't been home since," mom Angela McShane, 39, said.
While Alex regained control of his neck and left side and a bit of his right hand, it seemed unlikely that his right arm would come back on its own, McShane said. So she and husband Sean, 40, agreed to the surgery, wanting to give their son "every opportunity to get better," she said.
Belzberg is the first surgeon to attempt this kind of nerve rewiring on transverse myelitis patients and Alex's surgery was only the third time the procedure had been attempted.
"The surgery went well," Belzberg said.
McShane said Alex "is doing amazing," but there will be months of recovery before the success of the surgery can be gauged.
New Hope in Old Nerves
Chances of getting transverse myelitis are literally one in a million, said neurologist Dr. Daniel Becker, who heads pediatric restoration therapy at the Kennedy Krieger Institute in Baltimore.
While it's not completely understood what causes it, the condition, as in Alex's case, is often triggered by a viral infection.
The inflammation associated with transverse myelitis comes on rapidly, sometimes within hours, otherwise within days, Becker said.
What begins as a sudden onset of lower back pain, muscle weakness and strange sensations in the extremities progresses to impaired movement and paralysis in various parts of the body and loss of bladder and bowel control.
About a third of patients will regain most of their nerve function, a third will have moderate nerve damage and the remaining third will have significant permanent damage, Becker said.
In Alex's case, "his recovery was quite poor," and he was left with severe weakness on his left side, breathing difficulties and paralysis of his right arm and shoulder, Belzberg said.
While steroids are administered to reduce the inflammation in the early stages, once the damage is done, the only treatment is aggressive physical therapy to try to increase the function of the remaining healthy nerves.
If the nerves haven't healed on their own within the first three to six months, it is unlikely they ever will, Belzberg said. Six months out, Alex was at the point where the chances of his regaining function were "very, very poor," he added.
This is where Belzberg's novel surgical approach came in.
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