RT Journal Article
SR Electronic
T1 A Case Series of Acute Flaccid Myelitis in Pediatric Patients (P2.317)
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP P2.317
VO 90
IS 15 Supplement
A1 Marcus, Lydia
A1 Ness, Jayne
YR 2018
UL http://n.neurology.org/content/90/15_Supplement/P2.317.abstract
AB Objective: Compare children with acute flaccid myelitis (AFM) with onset after August 2014 to children with similar presentation before August 2014.Background: The CDC defined AFM as acute flaccid limb weakness and spinal cord grey matter injury in patients ≤21 with onset after August 1st 2014. An increase in AFM cases coincided with an outbreak of enterovirus D68 infections in 2014, leading to a hypothesized association between the two processes. While similar cases of flaccid paralysis had previously been observed, they had not been labeled AFM.Design/Methods: A tertiary children’s hospital demyelinating database with >500 patients prospectively enrolled since 2000 was queried for patients with flaccid weakness. Children with flaccid weakness onset prior to 2014 (n=5) were compared to children with AFM (n=6) with respect to demographics, clinical and MRI features, laboratory studies, treatment and outcomes.Results: The groups were similar with respect to age (mean 7.3 years pre-2014 vs 7.9 years post-2014), sex (40% vs 67% female) and race (40% vs 67% Caucasian). Weakness was isolated to one limb (40% vs 33%) or in multiple limbs (60% vs 67%). 80% of pre-2014 children and 100% of post-2014 children had MRI cervical spinal cord involvement. Both groups showed minimal clinical recovery despite aggressive treatment with immunotherapy. Post-2014 cases featured higher incidence of fever (100% vs 40%), recent infection (100% vs 60%), and hyperacute onset (67% vs 40%). Additionally, the post-2014 group demonstrated more elevated CSF protein (52.8 vs 26.8 mean, p-value 0.0032) and WBC count (50.4 vs 3.17, p-value 0.0147). Enterovirus was not detected in any pre-2014 children, but in half the post-2014 children.Conclusions: Although the etiology of AFM has not been definitively determined, increased inflammatory markers in post-2014 patients suggest a potential distinct underlying cause. Regardless of etiology, both groups experienced poor recovery, pointing to an unmet need for improved treatments.Disclosure: Dr. Marcus has nothing to disclose. Dr. Ness has nothing to disclose.