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Recognition and Management of Acute Flaccid Myelitis in Children

Gary R Nelson1, Joshua L Bonkowsky1, Elizabeth Doll1

  • 1Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.

Pediatric Neurology
|December 2, 2015
PubMed

Insights

Acute flaccid myelitis outbreaks in children caused spinal cord gray matter lesions. Most patients experienced lasting motor deficits despite treatment, highlighting the need for early diagnosis and management.

Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Disease

Background:

  • An outbreak of acute flaccid myelitis (AFM) occurred in US pediatric patients during 2014-2015.
  • A key characteristic of AFM cases was spinal cord gray matter localization.

Purpose of the Study:

  • To describe the clinical presentation and outcomes of pediatric patients with acute flaccid myelitis.
  • To inform clinicians on diagnosis, treatment, and prognosis for AFM.

Main Methods:

  • Retrospective case series of 11 children (13 months to 14 years) in the Intermountain West.
  • Clinical evaluation, neurological examination, and magnetic resonance imaging (MRI) of the spinal cord.
  • Assessment of treatment response to intravenous immunoglobulin, corticosteroids, or plasma exchange.

Main Results:

  • All 11 children presented with acute paralysis, with 10 showing spinal cord localization.
  • MRI revealed spinal gray matter lesions consistent with acute myelitis in all patients; no infectious cause was identified.
  • Despite treatment, 90% of children had residual motor deficits at follow-up.

Conclusions:

  • Early recognition of AFM is crucial for appropriate diagnostic imaging and laboratory testing.
  • Treatment initiation and accurate prognostic information are vital for affected families.
  • Unlike other causes of acute flaccid paralysis, AFM frequently results in persistent neurological deficits.
Abstract

Keywords:
Guillain-Barré syndromeenterovirusflaccid paralysismyelitispoliomyelitis

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