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:
CAP, LB, BG, KM, and CLS are unpaid advisors to the AFM Task Force of the US Centers for Disease Control and Prevention (CDC). ML serves (unpaid) on the UK AFP Task Force and is the lead for the Clinical Working Group. SEH, CO, and GYG receive salary support from the CDC for AFM surveillance. LB reports research support from Biogen outside the submitted work, and is serving as a consultant to the national vaccine injury compensation programme. RB reports grants from Akili interactive; and personal fees from EMD Serono, Roche Genentech, Novartis, Alexion, Sanofi Genzyme, and Biogen, outside the submitted work. JDes reports receiving funds from EFGLA, UCB, Novartis, Ovid, Aquestive, and Neurelis, and for serving on advisory boards as medico-legal expert. BG reports grants from National Institutes of Health, National MS Society, Siegel Rare Neuroimmune Association, Guthy Jackson Charitable Foundation, and CLENE Nanomedicine; personal fees from Novartis, Genentech, EMD Serono, and Alexion, outside the submitted work; and serves as board member to Siegel Rare Neuroimmune Association. RK reports grants from Ministry of Health, Labour and Welfare of Japan for AFM study, and personal fees from Eisai, Otsuka Pharmaceutical, and UCB Japan, outside the submitted work. ML receives research grants from Action Medical Research, the Dancing Eyes Syndrome society, Great Ormond Street Hospital Children's (GOSH) charity, National Institute for Health Research, MS Society, and Sparks charity; receives research support grants from the London Clinical Research Network and Evelina Appeal; has received consultation fees from CSL Behring, Novartis, and Octapharma; has received travel grants from Merck Serono; and was awarded educational grants to organise meetings by Novartis, Biogen Idec, Merck Serono, and Bayer. KM reports grants from the National Institute of Allergy and Infectious Diseases, outside the submitted work. TLS reports to have received a stipend from the American Academy of Neurology for lecturing on AFM. KTT reports grants by the National Institute of Health. EAY reports grants from the Canadian Network of MS Clinics, during the conduct of the study; grants from Biogen, National MS society, Consortium of Multiple Sclerosis Centers, MS Society of Canada/MS Foundation, Ontario Institute for Regenerative Medicine, Stem Cell Network, Sickkids Foundation, Centre for Brain and Mental Health, TEVA Pharmaceuticals, and Guthy Jackson Foundation; and personal fees from ACI Clinical, US Food and Drug Administration, and Juno, outside the submitted work. CAP reports grants from the National Institute of Health and Bart McLean Fund for Neuroimmunology Research, serves as co-investigator in the Natural History Study of Acute Flaccid Myelitis, and serves as a member of the National Institute of Health Scientific Board of the Siegel Rare Neuroimmune Association. All other authors declare no competing interests.
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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U2 - 10.1016/S0140-6736(20)32723-9
DO - 10.1016/S0140-6736(20)32723-9
M3 - Review article
C2 - 33357469
AN - SCOPUS:85099040803
VL - 397
SP - 334
EP - 346
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 10271
ER -