Nerve transfer as a novel treatment for West Nile virus-associated acute flaccid paralysis

Published:October 15, 2019DOI:https://doi.org/10.1016/j.jns.2019.116502
      West Nile virus-associated acute flaccid paralysis (WNV-AFP) is a well-known complication of West Nile neuroinvasive disease (WNND) [
      • Sejvar J.J.
      • Bode A.V.
      • Marfin A.A.
      • Campbell G.L.
      • Ewing D.
      • Mazowiecki M.
      • et al.
      West Nile virus-associated flaccid paralysis.
      ,
      • Gea-Banacloche J.
      • Johnson R.T.
      • Bagic A.
      • Butman J.A.
      • Murray P.R.
      • Agrawal A.G.
      West Nile virus: pathogenesis and therapeutic options.
      ]. Most cases of WNV-AFP occur as a result of anterior horn cell damage, resulting in a syndrome reminiscent of poliomyelitis. Brachial plexus involvement has been reported less commonly [
      • Almhanna K.
      • Palanichamy N.
      • Sharma M.
      • Hobbs R.
      • Sil A.
      Unilateral brachial plexopathy associated with West Nile virus meningoencephalitis.
      ,
      • Scholz S.
      • Kaas B.
      • Simpkins A.
      • Lyons J.
      • Venkatesan A.
      • Probasco J.
      Brachial plexitis preceding encephalomyelitis in a patient with West Nile virus infection.
      ,
      • Chahil M.
      • Nguyen T.P.
      West Nile virus-associated brachial plexopathy.
      ]. At present, supportive care is the mainstay of treatment for all forms of WNND [
      • Gea-Banacloche J.
      • Johnson R.T.
      • Bagic A.
      • Butman J.A.
      • Murray P.R.
      • Agrawal A.G.
      West Nile virus: pathogenesis and therapeutic options.
      ]. The prognosis of WNV-AFP is generally poor, and recovery, if any, usually occurs within six months of onset [
      • Sejvar J.J.
      • Bode A.V.
      • Marfin A.A.
      • Campbell G.L.
      • Pape J.
      • Biggerstaff B.J.
      • et al.
      West Nile virus-associated flaccid paralysis outcome.
      ].

      Keywords

      Abbreviations:

      CMAP (compound muscle action potential), EMG (electromyography), EV-71 (enterovirus-71), NCS (nerve conduction study), SNAP (sensory nerve action potential), WNND (West Nile neuroinvasive disease), WNV (West Nile virus), WNV-AFP (West Nile virus-associated acute flaccid paralysis)
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