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Acute flaccid myelitis: A clinical review of US cases 2012-2015
Kevin Messacar1,2, Teri L Schreiner3, Keith Van Haren4
1Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO. Kevin.messacar@childrenscolorado.org.
Abstract:
This review highlights clinical features of the increasing cases of acute flaccid paralysis associated with anterior myelitis noted in the United States from 2012 to 2015. Acute flaccid myelitis refers to acute flaccid limb weakness with spinal cord gray matter lesions on imaging or evidence of spinal cord motor neuron injury on electrodiagnostic testing. Although some individuals demonstrated improvement in motor weakness and functional deficits, most have residual weakness a year or more after onset. Epidemiological evidence and biological plausibility support an association between enterovirus D68 and the recent increase in acute flaccid myelitis cases in the United States. Ann Neurol 2016;80:326-338.
Insights
Acute flaccid myelitis, a condition causing limb weakness, has increased in the US. Enterovirus D68 is strongly suspected as the cause of these cases.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Acute flaccid myelitis (AFM) is characterized by sudden limb weakness.
- AFM involves spinal cord gray matter lesions or motor neuron injury.
- Cases of AFM have notably increased in the United States between 2012 and 2015.
Purpose of the Study:
- To review the clinical features of recent acute flaccid myelitis cases.
- To explore the association between enterovirus D68 and AFM.
- To understand the outcomes for individuals with AFM.
Main Methods:
- Review of clinical data from AFM cases in the US (2012-2015).
- Analysis of epidemiological trends and biological plausibility.
- Correlation of clinical presentation with potential infectious agents.
Main Results:
- Most patients with AFM experienced residual motor weakness over a year post-onset.
- Clinical features of AFM were documented.
- Enterovirus D68 is epidemiologically and biologically linked to the rise in AFM.
Conclusions:
- Enterovirus D68 is a likely cause of the increased AFM cases.
- AFM often results in persistent motor deficits.
- Further research into AFM pathogenesis and treatment is warranted.
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