Acute Flaccid Myelitis: Characteristics and Outcomes in 2014 and 2016 Clusters (S40.008)

2017 
Objective: 1) We present a case series of 14 children meeting CDC criteria for acute flaccid myelitis (AFM) in 2014 and 2016; and 2) Compare clinical presentations, treatment regimens, and outcomes. Background: AFM is defined by acute onset of focal limb weakness with a spinal cord lesion restricted to gray matter and spanning ≥1 segments. In 2014, 120 cases were reported in the USA, and more cases emerged in fall 2016. AFM causes significant morbidity, and more information regarding therapeutic options and outcome is required. Design/Methods: Case series of children presenting to The Children’s Hospital of Philadelphia between September 2014 and October 2016 meeting CDC criteria for confirmed or probable AFM. Results: We describe 5 children from 2014 and 9 from 2016. Children presenting in 2016 are more likely to have multi-limb involvement (78% versus 20%, p=.036), but not significantly younger (median age 2 y 7 mo versus 5 y 5 mo, p=.64), or more likely to require intensive care (56% vs 20%, p=.198) Treatments included IV corticosteroids (n=6), IVIG (N=14), and fluoxetine (n=8, 2016 patients only). At 2 years post-onset, four of five children presenting in 2014 demonstrated marked improvement, one minimal recovery, but none regained full function. At present, all nine children presenting in 2016 have significant weakness. Conclusions: AFM is a serious illness with marked impairment in function, risk of respiratory failure, and incomplete recovery. Patients presenting in 2016 in Philadelphia are more likely to have multi-limb involvement. While enteroviral DNA was found in biological fluids in 10 of 14 patients, precise causality remains to be established and host factors that predispose to anterior horn cell involvement remain to be defined. Clinicians are encouraged to promptly report any possible AFM cases to the CDC for ongoing epidemiologic surveillance. Therapeutic and possibly vaccination strategies are areas of need. Disclosure: Dr. Hopkins has received personal compensation for activities with Shire Pharmaceuticals for Advisory Board activities. Dr. Mcguire has nothing to disclose. Dr. Swami has nothing to disclose. Dr. Ulloa has nothing to disclose. Dr. Banwell has received personal compensation for activities with Novartis. Dr. Banwell has received personal compensation in an editorial capacity for Multiple Sclerosis and Related Disorders.
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