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Updated: Aug 26, 2025
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers
Julia Kozlowski1, Joseph R Linzey2, Whitney E Muhlestein2
1From the School of Medicine.
Background:
Acute flaccid myelitis (AFM) is a devastating neurologic condition in children, manifesting as acute limb weakness and/or paralysis. Despite increased awareness of AFM following initiation of U.S. surveillance in 2014, no treatment consensus exists. The purpose of this systematic review was to summarize the most current knowledge regarding AFM epidemiology, cause, clinical features, diagnosis, and supportive and operative management, including nerve transfer.
Methods:
The authors systematically reviewed the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using multiple databases to search the keywords ("acute flaccid myelitis"), ('acute flaccid myelitis'/exp OR 'acute flaccid myelitis'), and (Acute AND flaccid AND myelitis). Included articles reported on (1) AFM diagnosis and (2) patient-specific data regarding epidemiology, cause, clinical features, diagnostic features, or management of AFM.
Results:
Ninety-nine articles were included in this review. The precise cause and pathophysiologic mechanism of AFM remain undetermined, but AFM is strongly associated with nonpolio enterovirus infections. Clinical presentation typically comprises preceding viral prodrome, pleocytosis, spinal cord lesions on T2-weighted magnetic resonance imaging, and acute onset of flaccid weakness/paralysis with hyporeflexia in at least one extremity. Supportive care includes medical therapy and rehabilitation. Early studies of nerve transfer for AFM have shown favorable outcomes for patients with persistent weakness.
Conclusions:
Supportive care and physical therapy are the foundation of a multidisciplinary approach to managing AFM. For patients with persistent limb weakness, nerve transfer has shown promise for improving function in distal muscle groups. Surgeons must consider potential spontaneous recovery, patient selection, donor nerve availability, recipient nerve appropriateness, and procedure timing.
Insights
Acute flaccid myelitis (AFM) is a neurologic condition causing limb weakness in children. While its cause is unknown, supportive care and physical therapy are key, with nerve transfer showing promise for persistent weakness.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Acute flaccid myelitis (AFM) is a serious condition in children characterized by acute limb weakness or paralysis.
- Despite increased surveillance, a definitive treatment consensus for AFM is lacking.
- This systematic review synthesizes current knowledge on AFM's epidemiology, etiology, clinical presentation, diagnosis, and management.
Approach:
- A systematic literature review was conducted following PRISMA guidelines.
- Multiple databases were searched using keywords related to acute flaccid myelitis.
- Articles reporting on AFM diagnosis and patient-specific data were included.
Key Points:
- The exact cause of AFM remains undetermined but is strongly linked to nonpolio enteroviruses.
- Typical AFM presentation includes a viral prodrome, spinal cord lesions on MRI, and sudden onset of flaccid paralysis.
- Supportive care, including medical therapy and rehabilitation, is fundamental.
Conclusions:
- A multidisciplinary approach involving supportive care and physical therapy is the cornerstone of AFM management.
- Nerve transfer surgery demonstrates potential for improving function in children with persistent limb weakness due to AFM.
- Surgical considerations include spontaneous recovery, patient selection, and nerve graft suitability.
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