Nerve Transfer May Restore Function in Stroke Victims

Read the caveats carefully, I wouldn't do this except as a very last resort, my spasticity is not bad enough to consider this. 
https://www.medpagetoday.com/neurology/generalneurology/70030?

Significant improvements seen for spastic arm hemiplegia in Chinese study

• by Scott Harris, Contributing Writer, MedPage Today December 20, 2017

Action Points

• Note that this small trial suggests that contralateral C7 nerve transfer may improve function in the upper arm of those with spastic hemiparesis.
• Be aware that the large effect size and short time-frame should engender some skepticism; larger trials are needed.

A promising but controversial nerve transfer technique can help treat spastic hemiplegia, the paralysis caused by stroke and conditions like cerebral palsy, in the arm and hand.
That's according to a study published Wednesday in The New England Journal of Medicine.
"Transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in function and reduction of spasticity than rehabilitation alone over a period of 12 months," wrote Mou-Xiong Zheng, MD, PhD, a hand surgeon with Huashan Hospital in Shanghai, China, and colleagues. "Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand."
But in an accompanying editorial, Robert Spinner, MD, a neurosurgeon and orthopedic surgeon with the Mayo Clinic, and two colleagues urged caution.
They called the results "exciting" but questioned whether "connectivity" occurred as a direct result of the procedure.
"The time frame for improvement is the major question: that distal muscles are functionally reinnervated in such a short time seems unlikely to us," Spinner and colleagues wrote. "An alternative hypothesis to explain the functional improvement is that there was reduction in limb spasticity and improved function through the normal motor pathways of the C5, C6, C8, and T1 nerves, and the effect may have been augmented by rehabilitation ... An improvement in function at 10 months cannot be readily explained as being predominantly a result of the contralateral nerve transfer, because nerves do not regenerate that quickly, fully or consistently."
Zheng and colleagues said a more extensive study might help shed more light on the initial findings.
"A larger cohort, followed for a longer period, would be necessary to determine whether cervical nerve transfer results in safe, consistent, and long-term improvements in the function of an arm that is chronically paralyzed as a result of a cerebral lesion," Zheng and colleagues wrote.
Spastic limb hemiplegia typically results from stroke, traumatic brain injury, or a condition like cerebral palsy. According to estimates, 30-60 percent of stroke survivors suffer from spastic limb hemiplegia. The C7 nerve accounts for approximately 20 percent of the nerve fibers comprising the brachial plexus. The C7 nerve transfer procedure uses a healthy C7 nerve as a "donor" to restore function in the injured plexus.
For approximately 5 years, Zheng and colleagues studied 36 spastic hemiplegia patients between 12-45 years old, in whom power and sensitivity were decreased but not absent in the affected hand. Half of the patients underwent C7 nerve transfer plus rehabilitation; half underwent only rehabilitation. Patients were excluded if they had systemic diseases such as diabetes mellitus or cardiopulmonary disease, developmental delay, or severe deformities.
Analyzing functional MRI test results, the mean changes in Fugl-Meyer Assessment (motor recovery) scores from baseline to 12 months were 17.7±5.6 in the surgery group and 2.6±2.0 in the control group, indicating significant improvement in the surgery group (difference 15.1; 95% CI 12.2 to 17.9; P<0.001). The score increases occurred at months 10 and 12 in the surgery group, Zheng and colleagues concluded.
Significant improvements in spasticity from baseline to 12 months were seen in all relevant joints with surgery, including elbow extension, forearm rotation, wrist extension, thumb extension, and extension of fingers two through five. For the surgery group, mean changes in active range of motion from baseline to 12 months was 23±13 degrees at the elbow, 36±19 degrees in forearm rotation, and 49±21 degrees at the wrist. In the control group, the changes were 0±3, 1±5, and 1±5 degrees (P<0 .001="" all="" between-group="" comparisons="" for="" p=""> At 12 months, 16 of the 18 surgery patients could use the affected hand to perform three or more basic tasks. In the control group, seven of the 18 patients could perform two tasks, three could perform one, and eight could perform none.
"The paralyzed arm showed improved power, function, and reduced spasticity at month 12 in the surgery group, whereas there was significantly less improvement in the control group, in which patients received only physical therapy," Zheng and colleagues wrote.

The work had no commercial funding. All study authors declared they had no relevant financial interests other than government research grants. Spinner declared he had no relevant financial interests. His co-authors reported relationships with the Musculoskeletal Transplant Foundation, Acumed, Aptis Medical, and Synthes.

• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  New England Journal of Medicine

  Source Reference: Zheng M-X, et al "Trial of contralateral seventh cervical nerve transfer for spastic arm paralysis" New Engl J Med 2017; DOI: 10.1056/NEJMoa1615208.

• Secondary Source

  New England Journal of Medicine

  Source Reference: Spinner R, et al "Rewiring to regain function in patients with spastic hemiplegia" New Engl J Med 2017; DOI: 10.1056/NEJMe1713313.