Self-Assessment: New Frontiers in Nerve Injury | Interdisciplinary Care for Peripheral Nerve Injuries-Session recording- New Frontiers in Nerve Injury

Video Transcription

Video Summary

This session, moderated by neuromuscular neurologist Dr. Sarada Sakamori at Stanford, focused on emerging therapeutic approaches and outcome prediction in nerve injury. Dr. Thomas Wilson discussed the clinical application of low-frequency electrical stimulation (ES) to promote axonal regeneration by stimulating proximal to nerve injuries. Clinical trials in cubital and carpal tunnel syndrome indicate improved electrodiagnostic and functional recovery following intraoperative or post-operative ES, although optimal stimulation parameters remain under study, with recent trends favoring shorter, intraoperative protocols.<br /><br />Dr. Colin Franz elaborated on the mechanistic basis of ES from preclinical models, emphasizing that one hour of 20 Hz ES enhances motor neuron regeneration via upregulation of brain-derived neurotrophic factor (BDNF) and cyclic AMP signaling pathways. He highlighted challenges including lead displacement and explored novel wireless, biodegradable stimulators delivering repeated therapy over months, which may better accommodate human nerve regeneration timeframes. The session addressed the impact of a common BDNF polymorphism, which impairs activity-dependent BDNF secretion, potentially diminishing ES benefits in about one-third of the population.<br /><br />Additional novel therapies discussed were polyethylene glycol (PEG) axon fusion to restore severed nerve membranes, intermittent hypoxia to enhance spinal plasticity, and spinal cord stimulation, though evidence for some remains preliminary.<br /><br />Dr. Mike Berger emphasized the importance of interdisciplinary evaluations, early referral, and electrodiagnostic frameworks optimizing nerve transfer outcomes, especially as functional recovery can continue up to four years post-injury. He stressed limitations in current outcome measures like MRC strength grading, dynamometry, and subjective patient-reported tools. Quantitative motor unit number estimation and muscle ultrasound offer promise but lack standardization.<br /><br />Panel discussions highlighted challenges in patient rehabilitation, including variability in mastering nerve transfer control, and stressed the necessity of coordinated multidisciplinary care. Overall, the session underscored exciting advances in nerve repair therapeutics, the need for refined outcome assessments, and integrative clinical approaches to enhance patient recovery.

Keywords

neuromuscular neurology

nerve injury

electrical stimulation

axonal regeneration

cubital tunnel syndrome

carpal tunnel syndrome

CTS

brain-derived neurotrophic factor

BDNF polymorphism

polyethylene glycol axon fusion

intermittent hypoxia

spinal cord stimulation

nerve transfer outcomes