TY - JOUR
T1 - Acute flaccid myelitis
T2 - cause, diagnosis, and management
AU - AFM working group
AU - Murphy, Olwen C.
AU - Messacar, Kevin
AU - Benson, Leslie
AU - Bove, Riley
AU - Carpenter, Jessica L.
AU - Crawford, Thomas
AU - Dean, Janet
AU - DeBiasi, Roberta
AU - Desai, Jay
AU - Elrick, Matthew J.
AU - Farias-Moeller, Raquel
AU - Gombolay, Grace Y.
AU - Greenberg, Benjamin
AU - Harmelink, Matthew
AU - Hong, Sue
AU - Hopkins, Sarah E.
AU - Oleszek, Joyce
AU - Otten, Catherine
AU - Sadowsky, Cristina L.
AU - Schreiner, Teri L.
AU - Thakur, Kiran T.
AU - Van Haren, Keith
AU - Carballo, Carolina M.
AU - Chong, Pin Fee
AU - Fall, Amary
AU - Gowda, Vykuntaraju K.
AU - Helfferich, Jelte
AU - Kira, Ryutaro
AU - Lim, Ming
AU - Lopez, Eduardo L.
AU - Wells, Elizabeth M.
AU - Yeh, E. Ann
AU - Pardo, Carlos A.
AU - Salazar-Camelo, Andrea
AU - Mithal, Divakar
AU - Wilson-Murphy, Molly
AU - Bauer, Andrea
AU - Watkins, Colyn
AU - Abzug, Mark
AU - Dominguez, Samuel
AU - Press, Craig
AU - Yang, Michele
AU - Ahsan, Nusrat
AU - Ramos-Platt, Leigh
AU - Tiongson, Emmanuelle
AU - Seruya, Mitchel
AU - Tilton, Ann
AU - Katz, Elana
AU - Kirschen, Matthew
AU - Revivo, Gadi
N1 - Funding Information:
We are grateful for the support provided by the Siegel Rare Neuroimmune Association (SRNA) for facilitating administrative support to the AFM Working Group, and the Bart McLean Fund for Neuroimmunology Research for AFM research. We thank Janell A Routh and Sarah E Kidd at the Centers for Disease Control and Prevention for sharing their expertise. OCM was funded through the SRNA James T Lubin Fellowship. CAP is supported by National Institutes of Health (R01 NS108358) and the Bart McLean Fund for Neuroimmunology Research. KM is supported by National Institutes of Health (K23 AI128069). KTT is supported by National Institutes of Health (1K23NS105935).
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/1/23
Y1 - 2021/1/23
N2 - 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.
AB - 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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UR - http://www.scopus.com/inward/citedby.url?scp=85099040803&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(20)32723-9
DO - 10.1016/S0140-6736(20)32723-9
M3 - Review article
C2 - 33357469
AN - SCOPUS:85099040803
SN - 0140-6736
VL - 397
SP - 334
EP - 346
JO - The Lancet
JF - The Lancet
IS - 10271
ER -