Dr. Klein and Dr. Barbara contributed equally to this manuscript.
Surgical and postpartum hereditary brachial plexus attacks and prophylactic immunotherapy
Article first published online: 5 OCT 2012
Copyright © 2012 Wiley Periodicals, Inc.
Muscle & Nerve
Volume 47, Issue 1, pages 23–27, January 2013
How to Cite
Klein, C. J., Barbara, D. W., Sprung, J., Dyck, P. J. and Weingarten, T. N. (2013), Surgical and postpartum hereditary brachial plexus attacks and prophylactic immunotherapy. Muscle Nerve, 47: 23–27. doi: 10.1002/mus.23462
- Issue published online: 15 DEC 2012
- Article first published online: 5 OCT 2012
- Accepted manuscript online: 15 MAY 2012 12:00AM EST
- Manuscript Accepted: 8 MAY 2012
- brachial plexus
Surgery and childbirth can trigger attacks of hereditary brachial plexus neuropathy (HBPN), and inflammation was suggested as a component of the pathogenesis.
HBPN patients who underwent surgery or parturition from January 1, 1996 to December 31, 2009 were studied.
Twenty-five HBPN patients underwent 48 surgeries or parturitions. Seventeen patients (68%) had attacks, including 13 periprocedural and 7 postpartum by varied anesthesia types. Three patients who had 8 earlier combined attacks (after thyroidectomy, laminectomy, and Caesarean section) were given prophylactic immunosuppressive therapy (corticosteroids ± immunoglobulin). None suffered postoperative attacks, which is uncharacteristic of their prior experience. Five had perioperative attacks as their first HBPN manifestation. Median follow-up was 11 months (3–48 months). Attacks occurred in the operated limb (n = 6) or distant (n = 7) to surgical sites. All attacks interfered with daily living, with frequent incomplete recovery. Five patients had a SEPT9 mutation.
Corticosteroids may prevent parturition and surgical HBPN attacks in some patients. Diverse surgeries, anesthesia, and childbirth frequently trigger HBPN attacks. Muscle Nerve, 2013