Allan Belzberg, M.D., is a neurosurgeon specializing in surgery of the peripheral nervous system. As Director of Peripheral Nerve Surgery at The Johns Hopkins Hospital in Baltimore, he explains on this week’s On Call for All Kids how he successfully treats babies and children diagnosed with peripheral nerve damage at Johns Hopkins All Children’s Hospital in St. Petersburg.
What is the peripheral nervous system?
It involves the nerves. Think of them as the electric cables that leave the brain and the spinal cord and travel throughout the body and control the body. They are the nerves that come down and make your arms and hands work. They leave your spinal cord and make your legs work. They really make everything happen once they leave the brain or spinal cord.
We have heard of nerve damage in adults, but this can also happen in babies and children. How does it differ from adults?
The mechanism of an injury of the peripheral nerve in a child and adult is basically the same. A nerve can get stretched, compressed or cut. In rare instances, you can even have a tumor on a nerve. Motor vehicle accidents affect both children and adults and can result in nerve injuries. And in babies, the birthing process can cause severe brachial plexus injuries.
At what point do babies and children need to see a specialist about peripheral nerve damage?
In many cases an obstetrician will notice peripheral nerve damage at birth, or a pediatrician will notice that one of the baby’s arms or hands may not be working well. Once the pediatrician makes that diagnosis and follows the patient for a period of time, they may conclude it is peripheral nerve damage. That’s when they will refer the patient to a specialist.
What’s the process and treatment once you see the patient?
We try to start these children as soon as possible with either physical or occupational therapy in order to keep the extremities moving. Then we schedule the child for our multidisciplinary clinic at Johns Hopkins All Children’s Hospital.
What happens in the multidisciplinary clinic?
This is a clinic where many specialists come together in one room. The team consists of a neurosurgeon, orthopaedic surgeon, a rehabilitation doctor and physical and occupational therapists. We formulate a plan of care for the patient with the parents. We may also design a therapy program, so the patient will not need to come to the hospital and can be treated closer to home. We design a program specific to the child.
Why is research also important?
When we see a child with a nerve injury, we may not have a solution. With the resources at Johns Hopkins All Children’s Hospital, we can take these medical questions to the laboratory with our scientists and sometimes using computers to arrive at possible solutions. That’s a very unique thing. There are very few centers in the world that can do this.
How many of these cases actually will require surgery?
Children have a remarkable ability to heal their body. By far, the vast majority of peripheral nerve injuries do not need surgery. Only a very small proportion of these children will require surgery. When surgery is needed, sometimes it is directed at the nerve itself and we repair the nerve. Or in certain situations, we “rewire” the way things are working, but that’s uncommon. Occasionally, a child may need more surgery later in life. Our goal is to maximize whatever nature can do. We are going to provide the best possible outcome for that child.
On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report.