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Brain plasticity in neonatal brachial plexus palsies: quantification and comparison with adults’ brachial plexus injuries

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Abstract

Purpose

To compare two populations of brachial plexus palsies, one neonatal (NBPP) and the other traumatic (NNBPP) who underwent different nerve transfers, using the plasticity grading scale (PGS) for detecting differences in brain plasticity between both groups.

Methods

To be included, all patients had to have undergone a nerve transfer as the unique procedure to recover one lost function. The primary outcome was the PGS score. We also assessed patient compliance to rehabilitation using the rehabilitation quality scale (RQS). Statistical analysis of all variables was performed. A p ≤ 0.050 set as criterion for statistical significance.

Results

A total of 153 NNBPP patients and 35 NBPP babies (with 38 nerve transfers) met the inclusion criteria. The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months). The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma. All transfers performed in NBPP patients had a maximum PGS score of 4. This was not the case for the NNBPP population that reached a PGS score of 4 in approximately 20% of the cases. This difference was statistically significant (p < 0.001). The RQS was not significantly different between groups.

Conclusion

We found that babies with NBPP have a significantly greater capacity for plastic rewiring than adults with NNBPP. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.

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Authors and Affiliations

  1. Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, 1428, Buenos Aires, Argentina

    Mariano Socolovsky, Gilda di Masi, Gonzalo Bonilla & Ana Lovaglio

  2. Peripheral Nerve & Brachial Plexus Surgery Program, Department of Physiotherapy and Rehabilitation, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina

    Danilo Battaglia

  3. Department of Neurology, Universidad Abierta Interamericana, Buenos Aires, Argentina

    Roberto Rosler

  4. Department of Neurosurgery, University of Leiden School of Medicine, Leiden, Holland

    Martijn Malessy

  5. Peripheral Nerve & Brachial Plexus Surgery Unit, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Torre 2 5A, Buenos Aires, Argentina

    Mariano Socolovsky, Gilda di Masi, Gonzalo Bonilla & Ana Lovaglio

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  1. Mariano Socolovsky
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  7. Martijn Malessy
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Contributions

Conception and design: MS, GdM, and MM. Acquisition of data: DB, MS, AL, GdM, and GB. Analysis and interpretation of data: all authors. Drafting the article: MS, MM, and RR. Critically revising the article: MM and MS.

Corresponding author

Correspondence to Mariano Socolovsky.

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Conflict of interest

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings reported in this paper. No funding, grants, and financial or non-financial interests were involved directly or indirectly related to the work submitted for publication. All ethical standards than could be related during design, data collection, statistical analysis, writing, and editing this paper were accomplished, as well as any treatment of personal data from the patients involved.

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Socolovsky, M., di Masi, G., Bonilla, G. et al. Brain plasticity in neonatal brachial plexus palsies: quantification and comparison with adults’ brachial plexus injuries. Childs Nerv Syst 40, 479–486 (2024). https://doi.org/10.1007/s00381-023-06072-2

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