Acute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric cohort

Melicosta, Michelle; Dean, Janet; Hagen, Kaitlin; Oppenheimer, Kathleen; Porter, Courtney; Rybczynski, Suzanne; Salorio, Cynthia F.; Sadowsky, Cristina L.

doi:10.3233/prm-180549

Cited by 22 publications

(29 citation statements)

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“…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%

“…[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. 21,22 In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation.…”

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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute flaccid myelitis: cause, diagnosis, and management

et al. 2021

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“…In addition, nerve and muscle transfer surgeries may be considered to maximize function in select patients 8 . AFM patients are at risk for secondary complications such as joint subluxation, limb length discrepancies, scoliosis, and decreased bone density 9 . Close monitoring is required long term.…”

Section: Testing Recommendationmentioning

confidence: 99%

Acute Flaccid Myelitis: A Call for Vigilance and an Update on Management

Hopkins

Desai

Benson

2021

Pediatric Neurology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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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. Nerve and/or tendon transfer surgery is receiving increased consideration as another treatment option.…”

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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Acute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric cohort

Cited by 22 publications

References 22 publications

Acute flaccid myelitis: cause, diagnosis, and management

Acute flaccid myelitis: cause, diagnosis, and management

Acute Flaccid Myelitis: A Call for Vigilance and an Update on Management

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

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