Unmet Needs in the Evaluation, Treatment, and Recovery for 167 Children Affected by Acute Flaccid Myelitis Reported by Parents Through Social Media

Bove, Riley; Rowles, William; Carleton, Mia; Olivera, Erin; Sheehan, Mikell; Werdal, Heather; Scott, R.; Axton, LaMay; Benson, Lina

doi:10.1016/j.pediatrneurol.2019.08.009

Cited by 25 publications

(20 citation statements)

References 30 publications

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“…Bladder and bowel dysfunction are common in the acute phase, 23 and autonomic manifestations such as labile blood pressure or irregular heart rate and breathing patterns can occur. 18 Sensory symptoms or deficits other than neuropathic pain or paraesthesia are atypical. 49 Altered mental status is not common, 5,23,49 and the contribution of factors such as metabolic or respiratory disturbances in cases of reported encephalopathy is uncertain.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The extent of recovery in AFM is highly variable, although few patients (<10%) recover completely. 3,5,18,20,48 After neurological nadir (which may last days to weeks), most patients show some improvement in motor strength, with recovery being most rapid in the first few months after onset. Cranial nerve dysfunction is more likely to improve and resolve than is limb weakness.…”

Section: Acute Managementmentioning

confidence: 99%

“…Over the long term, patients can be affected by a range of neurological, musculoskeletal, and psychological sequelae. [18][19][20] Appropriate rehabilitation can improve functional status and quality of life after AFM. 19 Additionally, surgical approaches including tendon or nerve transfer surgery have been used in individual cases to manage residual impairments.…”

Section: Introductionmentioning

confidence: 99%

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Acute flaccid myelitis: cause, diagnosis, and management

et al. 2021

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Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Acute Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute flaccid myelitis: cause, diagnosis, and management

et al. 2021

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“…Intensive physical therapy, occupational therapy and ultimately rehabilitation services are a major component in the overall management of patients with AFM, with improvement of function in some patients with therapies even a year or more out from diagnosis 36–38. Clinicians should also be aware of potential secondary complications, including joint subluxation or dislocation, scoliosis37 and decreased bone density in patients unable to bear weight.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Update on acute flaccid myelitis: recognition, reporting, aetiology and outcomes

Hardy

Hopkins

2020

Arch Dis Child

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Acute flaccid myelitis, defined by acute flaccid limb weakness in the setting of grey matter lesions of the spinal cord, became increasingly recognised in 2014 following outbreaks in Colorado and California, temporally associated with an outbreak of enterovirus D68 respiratory disease. Since then, there have been biennial increases in late summer/early fall. A viral infectious aetiology, most likely enteroviral, is strongly suspected, but a definitive connection has yet to be established. Patients typically present with asymmetric weakness, maximal proximally, in the setting of a febrile illness. MRI demonstrates T2/FLAIR abnormalities in the central grey matter of the spinal cord, and cerebrospinal fluid typically shows a lymphocytic pleocytosis with variable elevation in protein. The weakness may be progressive over several days and involve respiratory muscles, making early recognition and close monitoring essential. Other complications in the acute period may include autonomic instability and bowel/bladder involvement. There is no clear recommended treatment at this time, although intravenous immunoglobulin, steroids and plasma exchange have been used. Intensive therapies and rehab services have shown benefit in maximising function, and surgical interventions may be considered in cases without optimal response to therapies. Close attention should also be paid to psychosocial factors. Prognosis is generally guarded, and additional factors that predict final outcome, including host factors and treatment effects, have yet to be elucidated. Multicentre collaborative efforts will be required to provide answers about this rare but serious disorder.

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“…At present, no proven treatments for AFM have been identified. Although some patients recover function, AFM is frequently associated with long-term neurologic deficits and impairment (11,12).…”

mentioning

confidence: 99%

Enterovirus D68–Associated Acute Flaccid Myelitis, United States, 2020

Kidd¹,

Lopez²,

Konopka-Anstadt³

et al. 2020

Emerg. Infect. Dis.

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A FM is a syndrome characterized by the acute onset of flaccid limb weakness and lesions in the gray matter of the spinal cord visible on magnetic resonance imaging; the lesions represent damage to the lower motor neurons in the anterior horns. This feature distinguishes AFM from other disorders associated with acute flaccid limb weakness or paralysis, such as disorders of peripheral nerves (e.g., Guillain-Barré syndrome) or neuromuscular transmission (e.g., myasthenia gravis or botulism). AFM can be caused by multiple infectious and noninfectious etiologies. Poliovirus, nonpolio enteroviruses, and flaviviruses are all known to cause AFM in a subset of persons who are infected (1-4). In addition, noninfectious etiologies such as neuroinflammatory conditions or spinal vascular disease can result in a clinical and radiographic picture that overlaps with that of AFM caused by infection (5-7). Although the

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Unmet Needs in the Evaluation, Treatment, and Recovery for 167 Children Affected by Acute Flaccid Myelitis Reported by Parents Through Social Media

Cited by 25 publications

References 30 publications

Acute flaccid myelitis: cause, diagnosis, and management

Acute flaccid myelitis: cause, diagnosis, and management

Update on acute flaccid myelitis: recognition, reporting, aetiology and outcomes

Enterovirus D68–Associated Acute Flaccid Myelitis, United States, 2020

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