AANEM News Express

AANEM News Express

Recognition and Management of Acute Flaccid Myelitis in Children

Submitted by Leigh Maria K. Ramos-Platt, MD, News Science Editorial Board

This is a retrospective study of 11 children from the US Intermountain West Region between the ages of 13 months and 14 years of age who presented with acute flaccid myelitis between the time period of February 2014 and January of 2015. Ten of 11 patients had involvement of at least one limb. The 11th patient had only cranial nerve involvement. A core feature of this disorder were T2 hyperintensities involving the anterior horn cells. One third of the patients also had involvement of brainstem and cerebellar nuclei. All patients had an abrupt onset followed by deterioration. Although most had CSF pleocytosis, it was not a feature in all patients. All received at least one modality of immunosuppressive therapy with approximately half receiving more than one immunosuppressive therapies (IVIG, PLEX, high dose pulse methylprednisolone). Unfortunately, also a core feature of this disorder is the chronic loss of function in at least one limb (only the patient who presented with solely cranial nerve involvement recovered completely). Although occurring at the time there was a spike in the incidence of enterovirus D68 infections, none of the patients were positive for this agent.
Comment: One point to be taken from this study is the importance of early imaging in pediatric patients who present with acute flaccid myelitis. The finding of T2 hyperintensities in the anterior horn cell region is a characteristic finding and can be distinguished from other disorders that can present similarly such as transverse myelitis and AIDP. Communication with the primary author of the study clarified that this is a separate population (from a different state) than results also of 11 children published in a different journal from the same period of time. This study confirms the poor prognosis of return to complete function of an affected limb with acute flaccid myelitis.

About the AANEM News Science Editorial Board
The board helps to highlight significant, timely science news items for AANEM members. It reviews articles in journals and websites, identifies newsworthy items in the field, and writes article summaries.

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