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Acute Flaccid Myelitis Among Hospitalized Children in Texas, 2016
Rachel Downey1, Dawn McElvain2, Donald K Murphey3
1Pediatric Infectious Diseases, Dell Children's Medical Group, Austin, Texas; Dell Children's Medical Center of Central Texas, Austin, Texas.
Insights
Acute flaccid myelitis (AFM) can cause limb weakness, with poor recovery rates and no standard treatment. Most children with AFM can perform daily activities independently or with mild deficits.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Acute flaccid myelitis (AFM) presents as acute limb weakness with spinal cord gray matter lesions.
- Limited data exist on long-term functional outcomes and definitive causes or treatments for AFM.
Purpose of the Study:
- To review the clinical presentation, treatments, and functional outcomes of children diagnosed with acute flaccid myelitis in Texas.
- To identify potential etiologies and assess recovery trajectories in pediatric AFM cases.
Main Methods:
- Retrospective review of 21 pediatric patients diagnosed with AFM in Texas during 2016.
- Data collection included medical history, illness presentation, treatments, laboratory and imaging studies, and functional outcomes up to two years post-onset.
Main Results:
- Treatments varied, with no observed differences in response to common therapies like IVIG, methylprednisolone, or plasmapheresis.
- A potential cause was identified in 57% of cases, including enterovirus D68 in four patients.
- While five patients fully recovered, 71% of the remaining patients could perform daily activities independently or with mild deficits.
Conclusions:
- No single cause or treatment modality was strongly supported for acute flaccid myelitis.
- The majority of pediatric AFM patients achieve functional independence or mild deficits in daily activities, despite variable recovery rates.
Background:
Acute flaccid myelitis is characterized by acute-onset flaccid limb weakness with predominantly gray matter lesions in the spinal cord spanning one or more segments. Rates of full recovery are poor, and there is no standard treatment or definitive cause.
Methods:
This is a retrospective review of children diagnosed with acute flaccid myelitis in Texas during 2016. Patients were identified through a Texas collaborative of six hospitals in four major metropolitan areas. Data abstraction included health history, illness presentation, medical treatments, laboratory studies, imaging data, recovery, and ability to perform activities of daily living up to approximately two years from illness onset.
Results:
Among all sites, 21 patients met inclusion criteria. Treatments varied with the most common being intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. No differences were seen in response to medical treatments. A potential etiology was found in 12 (57%) cases, including four with enterovirus D68. Five cases recovered fully. Of the 16 patients without full recovery, abilities ranged from (1) able to perform all activities of daily living for age independently (n = 5), (2) mild deficits (n = 5), and (3) substantial reliance on caregivers for activities of daily living (n = 6).
Conclusion:
Many reports describe symptoms and outcomes of acute flaccid myelitis, but limited data are available on long-term functional outcomes. We were unable to make a strong case for any single cause or treatment modality. Fortunately, the majority of patients (15, 71%) were able to perform activities of daily living with complete independence or only mild deficits.
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