Analysis of the Causes and Phenotypic Variations of Acute flaccid paralysis with and without myelitis in a Pediatric Hospital Setting in Taiwan

Abstract

Background: Acute flaccid paralysis (AFP) is a clinical syndrome marked by the sudden onset of muscle weakness or paralysis, posing a critical medical emergency due to its potential for rapid progression and significant morbidity and mortality. This study investigates the demographic and clinical characteristics, laboratory findings, and underlying causes of AFP in patients with and without myelitis (M-AFP and NM-AFP, respectively). Methods: Data were retrospectively collected from 39 patients diagnosed between 2012 and 2021, divided into M-AFP (n=22) and NM-AFP (n=17) groups. Patients with myelitis were identified via clinical symptoms and magnetic resonance imaging findings, while those without myelitis were diagnosed through clinical presentation and various diagnostic tools. Key demographic data, clinical characteristics, and laboratory results, such as cerebrospinal fluid white blood cell count and protein levels, were analyzed. Results: The study identified distinct etiologies for M-AFP, including multiple sclerosis, herpes simplex virus, and enterovirus, among others. In contrast, NM-AFP was associated with conditions such as polymyositis, Guillain-Barre syndrome, and hypokalemic periodic paralysis. Statistical analysis revealed significant differences in symptoms at onset, with limb numbness more prevalent in M-AFP and myalgia more common in NM-AFP. Although cerebrospinal fluid white blood cell counts were higher in M-AFP, the difference was not statistically significant. Conclusions: This comprehensive analysis highlights the diverse etiologies and clinical presentations of AFP, emphasizing the need for tailored diagnostic strategies to enhance patient care and outcomes.