Acute Flaccid Myelitis (AFM) has caused significant national and international concerns and garnered significant attention in the press. This syndrome is extremely similar to the flaccid paralysis caused by the poliovirus and there has been significant controversy about the suspected cause of recent outbreaks. Ample epidemiological evidence suggests an association with circulating enterovirus D68, but public heath officials have not labelled this as the predominant cause. Concern for a viral myelitis, however, led to treatment recommendations argue against anti-inflammatories such as corticosteroids and plasmaexchange, despite some experience to suggest that these therapies would be of significant value to some patients. 

The objective of this study was to classify the presentations, clinical symptoms, imaging symptoms and preclinical data for pediatric patients with acute flaccid myelitis. Cases from the 2014, 2016 and 2018 outbreaks are included as well as cases outside of these epochs in time. Outcomes, relative to treatments were analyzed.

This study collected data on over 60 patients with AFM seen at a single center. Data about clinical symptoms at onset, time to nadir, enterovirus testing, treatments used and outcomes were abstracted from charts. Analyses were performed to look for associations between imaging data, clinical presentations, viral testing and outcomes in the setting of various therapies. 

Of 44 patients with complete data sets, 20 were male and more than half had a prior URI or GI illness. 42 had cervical spine involvement with approximately half showing evidence of some mixed gray and white matter damage. Of those tested, approximately half were positive for the EVD68 virus. 40 patients received steroids and 23 received PLEX. The outcomes suggest safety and benefit of these therapies to the majority of patients receiving them.

Consideration should be given to updating public health guidelines about the etiology and treatment of acute flaccid myelitis.