Abstract
Objective: To study EMG/NCS abnormalities in clinical and radiologically confirmed AFM cases.
Background: AFM has emerged as important cause for acute flaccid paralysis (AFP) in young children. Studies using MRI of the spine and CSF/nasal viral swab studies have confirmed an acute viral attack (enterovirus ED68) on the anterior horn cells with residual motor weakness. However, studies describing EMG/NCS abnormalities in AFM are limited.
Design/Methods: Retrospective chart review of confirmed AFM cases (based on CDC criteria) between July to August 2016 at a tertiary Children’s Hospital in Atlanta, Georgia was performed. Clinical presentation, neurological examination, MRI brain and spine, CSF and viral studies, EMG/NCS testing, treatment and clinical course were recorded.
Results: Five boys with mean age 4.4 ± 2 years were identified. Prodromal illness included fever and upper respiratory infection symptoms 1 to 2 weeks prior to the onset of AFP. Neurological examination confirmed asymmetric motor weakness in arms and legs of all subjects, two subjects had additional respiratory weakness and need for intubation, ventilation and feeding tube. Deep tendon reflexes were absent with normal sensory examination. MRI spine showed T2 hyper-intensity diffuse in 60% (3/5) and focal in 40% (2/5). CSF studies showed elevated white count in 100% (5/5) and protein 60% (3/5). CSF enterovirus ED68 was positive in 20% (1/5). Motor NCS showed reduced distal motor amplitude, fibrillation potentials, positive sharp waves and unstable motor unit potentials on concentric needle electrode examination indicating diffuse acute neurogenic process affecting motor neurons and or its axon in 100 % (5/5) subjects. In all 100%(5/5) sensory NCS was normal. 60% (3/5) received immunomodulatory therapy (IVIG/PLEX/Steroids) without benefit and 100% (5/5) had residual motor weakness requiring inpatient 60% (3/5) and outpatient 40% (2/5)rehabilitation.
Conclusions: Acute diffuse neurogenic changes on EMG/NCS abnormalities are helpful in diagnosis of AFM in conjunction with neuroimaging.
Disclosure: Dr. Patel has nothing to disclose. Dr. Goyal has nothing to disclose. Dr. Verma has nothing to disclose.
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