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Acute flaccid myelitis: long-term outcomes recorded in the CAPTURE study compared with paediatric transverse myelitis
Benjamin Greenberg1, Patricia Plumb1, Gary Cutter2
1Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Background:
Since 2014, the USA has documented three outbreaks of acute flaccid myelitis (AFM). Unique features and treatment responses of this myelitis variant have not been prospectively studied. This study prospectively measured outcomes in paediatric myelitis patients relative to treatments.
Methods:
This was a prospective, multicentre, non-randomised, observational cohort study. The study duration was 5 years and the length of follow-up was 1 year. This study collected data from children and families in North America. Patients were enrolled at academic centres with expertise in myelitis or online via a web portal. Paediatric patients diagnosed with myelitis were eligible for enrolment in the study within 6 months of onset of symptoms. Patients were characterised as transverse myelitis (TM) or the AFM variant based on clinical and radiographic findings.
Results:
The cohort of 90 patients included patients with AFM and TM. Of the 51 patients with AFM there was evidence of two clinically relevant patterns. This included a grey matter restricted form of AFM and a cohort with concomitant white matter that could explain lower extremity motor deficits in patients with lesions restricted to the cervical spine. The improvement in deficits with the use of corticosteroids was similar to what was observed in the TM cohort (p=0.97).
Conclusions:
Clinicians should consider on a case by case basis the approach to therapy for AFM patients. Prospective controlled studies of long-term outcomes would be useful in this growing patient population.
Insights
Acute flaccid myelitis (AFM) and transverse myelitis (TM) share similar treatment responses to corticosteroids. This prospective study identified distinct AFM patterns, informing future therapeutic strategies for pediatric myelitis patients.
Area of Science:
- Neurology
- Pediatric Neurology
- Infectious Diseases
Background:
- The USA has experienced three outbreaks of acute flaccid myelitis (AFM) since 2014.
- Unique features and treatment responses of AFM have not been prospectively studied.
- This study aimed to prospectively measure outcomes in pediatric myelitis patients relative to treatments.
Purpose of the Study:
- To prospectively investigate clinical features and treatment outcomes in pediatric patients with myelitis, including acute flaccid myelitis (AFM) and transverse myelitis (TM).
- To identify distinct patterns within AFM cases and compare treatment responses between AFM and TM.
Main Methods:
- A prospective, multicenter, non-randomized, observational cohort study conducted over 5 years with 1-year follow-up.
- Data collected from pediatric patients diagnosed with myelitis within 6 months of symptom onset in North America.
- Patients classified as AFM or TM based on clinical and radiographic findings.
Main Results:
- The study included 90 patients with AFM and TM. Fifty-one AFM patients exhibited two patterns: grey matter restricted or concomitant white matter involvement.
- Corticosteroid treatment showed similar improvement in deficits for AFM and TM cohorts (p=0.97).
- Specific AFM patterns may explain motor deficits in patients with cervical spine lesions.
Conclusions:
- Treatment approaches for AFM should be individualized.
- Prospective controlled studies are needed to evaluate long-term outcomes in the growing AFM patient population.
