Surgical and postpartum hereditary brachial plexus attacks and prophylactic immunotherapy

Authors

  • Christopher J. Klein MD,

    Corresponding author
    1. Department of Neurology, Division of Peripheral Nerve Diseases and Medical Genetics, Mayo Clinic Foundation, 200 First Street S.W., Rochester, Minnesota, USA
    • Department of Neurology, Division of Peripheral Nerve Diseases and Medical Genetics, Mayo Clinic Foundation, 200 First Street S.W., Rochester, Minnesota, USA

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    • Dr. Klein and Dr. Barbara contributed equally to this manuscript.

  • David W. Barbara MD,

    1. Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
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    • Dr. Klein and Dr. Barbara contributed equally to this manuscript.

  • Juraj Sprung MD, PhD,

    1. Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
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  • Peter J. Dyck MD,

    1. Department of Neurology, Division of Peripheral Nerve Diseases and Medical Genetics, Mayo Clinic Foundation, 200 First Street S.W., Rochester, Minnesota, USA
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  • Toby N. Weingarten MD

    Corresponding author
    1. Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
    • Department of Neurology, Division of Peripheral Nerve Diseases and Medical Genetics, Mayo Clinic Foundation, 200 First Street S.W., Rochester, Minnesota, USA

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Abstract

Introduction:

Surgery and childbirth can trigger attacks of hereditary brachial plexus neuropathy (HBPN), and inflammation was suggested as a component of the pathogenesis.

Methods:

HBPN patients who underwent surgery or parturition from January 1, 1996 to December 31, 2009 were studied.

Results:

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.

Conclusions:

Corticosteroids may prevent parturition and surgical HBPN attacks in some patients. Diverse surgeries, anesthesia, and childbirth frequently trigger HBPN attacks. Muscle Nerve, 2013

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