January 31, 2020

Total repair of brachial plexus injuries? An exciting new development

Damage to the brachial plexus is a potentially serious event. This bundle of nerves connects the spinal cord to the shoulders, arms and hands, and damage to them can lead to loss of power and movement all the way down from the shoulder to the hand. Nerve-grafting surgery can sometimes assist, but even surgery will not guarantee a complete recovery.

However, Notre Dame University has recently discovered a way to regenerate nerves damaged in brachial plexus injuries. Their preliminary findings suggest that there might now be a way to restore much or even all function, a potentially life-changing development for those affected by Erb’s palsy.

What has been discovered?

The team at Notre Dame reviewed the ways in which nerves grew back following a brachial plexus injury, and compared this with how the same nerves grew in early life to connect the central (spinal) and peripheral nervous systems. Their aim was to look at the differences between these two processes, and see if there was a way to “persuade” the damaged nerves to replicate what they had done in the womb.

Surprisingly, the team did not use stem-cells (an exciting area in medicine at present). Rather, they discovered a drug-based therapy (“chemotherapy”), using an agent called Paclitaxel.

How has this helped with brachial plexus injury?

Put at its simplest, nerves called dorsal root ganglia (DRG) sensory axons penetrate the spinal cord. They then connect with specific types of neuron, which provide motor and sensory function for hands, arms and shoulders.

Following injuries to the brachial plexus, DRG sensory axons are unable to penetrate the spinal cord barrier when they try to regrow. Accordingly, the team’s drug therapy allowed the severed DRG sensory axons to enter the spinal cord. They discovered that when this was facilitated by the chemotherapy, the axons were able to connect up correctly with the relevant portions of the nervous system. The model aimed to provide full functional recovery after 48 hours – an astonishing result.

Whilst the aim of the study was primarily to assist patients suffering from a brachial plexus injury caused during birth, the study’s authors believe that potentially patients injured much later in life (in road traffic accidents, for example) could benefit.

The research is still at an early stage and the team aims to use its initial findings to identify more specifically-targeted strategies for regeneration. However, even these early results are tremendous news for Erb’s palsy sufferers.

As always in medicine, prevention is better than cure. It is thus vital that high standards in birthing units are achieved, so that the excellent results in relation to Erb’s palsy reported at Southmead in Bristol can be replicated elsewhere.

This is a complex and developing area of medico-legal practice, and if you or a member of your family have been affected by Erb’s palsy it is vital that you obtain suitably specialised advice.

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