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| [PMID]: | 29262271 |
| [Au] Autor: | Zheng MX; Hua XY; Feng JT; Li T; Lu YC; Shen YD; Cao XH; Zhao NQ; Lyu JY; Xu JG; Gu YD; Xu WD |
| [Ad] Endereço: | From the Department of Hand Surgery, Huashan Hospital (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), the National Clinical Research Center for Aging and Medicine (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), Department of Biostatisti |
| [Ti] Título: | Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis. |
| [So] Source: | N Engl J Med;378(1):22-34, 2018 01 04. | | [Is] ISSN: | 1533-4406 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | BACKGROUND: Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with spastic arm paralysis due to chronic cerebral injury. METHODS: We randomly assigned 36 patients who had had unilateral arm paralysis for more than 5 years to undergo C7 nerve transfer plus rehabilitation (18 patients) or to undergo rehabilitation alone (18 patients). The primary outcome was the change from baseline to month 12 in the total score on the Fugl-Meyer upper-extremity scale (scores range from 0 to 66, with higher scores indicating better function). Results The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft. RESULTS: The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft. CONCLUSIONS: In this single-center trial involving patients who had had unilateral arm paralysis due to chronic cerebral injury for more than 5 years, 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. Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand. (Funded by the National Natural Science Foundation of China and others; Chinese Clinical Trial Registry number, 13004466 .). |
| [Mh] Termos MeSH primário: |
Braço/inervação
Hemiplegia/cirurgia
Espasticidade Muscular/cirurgia
Transferência de Nervo
Nervos Periféricos/transplante
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| [Mh] Termos MeSH secundário: |
Potenciais de Ação
Adolescente
Adulto
Encéfalo/diagnóstico por imagem
Lesões Encefálicas Traumáticas/complicações
Paralisia Cerebral/complicações
Avaliação da Deficiência
Hemiplegia/etiologia
Hemiplegia/reabilitação
Seres Humanos
Masculino
Espasticidade Muscular/etiologia
Espasticidade Muscular/reabilitação
Transferência de Nervo/efeitos adversos
Nervos Periféricos/anatomia & histologia
Nervos Periféricos/fisiologia
Acidente Vascular Cerebral/complicações
Adulto Jovem
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T |
| [Em] Mês de entrada: | 1801 |
| [Cu] Atualização por classe: | 180118 |
[Lr] Data última revisão:
| 180118 |
| [Sb] Subgrupo de revista: | AIM; IM |
| [Da] Data de entrada para processamento: | 171221 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1056/NEJMoa1615208 |
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