Abstract
Objective: To determine the outcomes among children diagnosed with acute flaccid myelitis who were treated with steroids, IVIG and plasma exchange.
Background: Acute Flaccid Myelitis (AFM) has effected hundreds of children throughout the world. Clearly recognized as a variant of transverse myelitis in after an outbreak in 2014 there has been significant controversy about both the cause and the recommended approach to treatment. Most data supports a relationship between Enterovirus D68 and this paralytic condition. Since it’s recognition there has been a controversy about whether the syndrome is infectious or post infectious and whether it’s potential infectious etiology would be a contraindication to the use of corticosteroids or PLEX. Early recommendations from the CDC supported the use of IVIG in children diagnosed with AFM and cautioned against the use of steroids or PLEX without outcomes data to reference. Given the lack of therapies available for AFM patients a review of outcomes data could help guide clinicians.
Design/Methods: Outcomes data from pediatric AFM patients was collected under an IRB approved protocol. Cases were defined based on the clinical and radiographic evidence of significant gray matter involvement. Treatment regimens were recorded and motor outcomes were recorded.
Results: Outcomes from 30 pediatric AFM patients were reviewed. Limb strength, ventilatory status and mobility was recorded and assessed relative to treatments prescribed. Data will be presented that supports the use of corticosteroids and PLEX in AFM patients with upper motor neuron deficits.
Conclusions: Children with AFM and evidence of white matter involvement appear to benefit from the use of steroids and/or PLEX therapy. Presumably, this might suggest that while the anterior horn cell damage in AFM is likely mediated by viral infection while upper motor neuron damage may be mediated by an inflammatory pathophysiology.
Study Supported by: The Transverse Myelitis Association
Disclosure: Dr. Greenberg has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis, Alexion, EMD Serono. Dr. Plumb has nothing to disclose. Dr. Wang has nothing to disclose.
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