Recognition and Management of Acute Flaccid Myelitis in Children

Acute flaccid myelitis: A clinical review of US cases 2012–2015

“…8 Ten children meeting the CDC AFM case definition and 1 additional child with cranial nerve dysfunction presenting to Primary Children’s Hospital (PCH) in Utah during the 2014 enterovirus D68 outbreak were subsequently reported. 10 Tables 1 and 2 summarize clinical characteristics of the CDPH, CHCO, and PCH cohorts of AFM described above, as well as nation-wide CDC epidemiological data. Of note, CDC nation-wide epidemiological data include 24 CDPH, 9 CHCO, and 10 PCH cases.…”

“…6,8 In the CHCO and PCH clusters, 3 children had cranial nerve dysfunction without the associated limb weakness required to meet CDC AFM case definition. 7,10 Hypophonia, dysarthria, and dysphagia consistent with CN IX and X dysfunction; diplopia attributed to cranial nerve VI dysfunction; and facial weakness attributed to cranial nerve VII dysfunction were most common. 7,8 Seizures were reported in 4% of AFM cases from CDC surveillance.…”

Clinical Reasoning: A 2-year-old child with acute flaccid paralysis

“…Bladder or bowel dysfunction was present in 28% of the patients at onset and neurogenic bladder was noted on longterm follow-up. 10 A similar number of patients had ventilatory or feeding support, underscoring the potential of bulbar and respiratory muscle involvement in these patients. The clinical hallmark of weakness is flaccid limb weakness with hyporeflexia and intact sensation.…”

“…3,8,10 Clinical follow-up at 30 days showed no or limited improvement of limb weakness in the majority of the patients. 8 On long-term follow-up, most cases had improved with residual motor deficits.…”

“…8 On long-term follow-up, most cases had improved with residual motor deficits. 10 For these reasons, close follow-up and continued care with rehabilitative services including physical and occupational therapy is essential. Our patient made substantial recovery with residual deficit at 10 months follow-up.…”