Case Description Can Reliably Define Acute Flaccid Myelitis

A case description can reliably define patients with acute flaccid myelitis (AFM), according to a study published online Nov. 30 in JAMA Pediatrics.

Matthew J. Elrick, M.D., Ph.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a retrospective case analysis of 45 children younger than 18 years diagnosed with AFM between 2012 and 2016 using the U.S. Centers for Disease Control and Prevention case definition. Two groups of patients were recruited: one based on the CDC case definition of AFM and the second referred to the Johns Hopkins Transverse Myelitis Center for evaluation of suspected AFM. Three neurologists reviewed the patients' records and imaging data and identified patients with definable alternative diagnoses and those with restrictively defined AFM (rAFM).

The researchers found that 34 of the patients were classified as having rAFM and 11 had alternate diagnoses. The main factors that differed between the groups included asymmetry of weakness, lower motor neuron signs, preceding viral syndrome, symptoms evolving over hours to days, absence of sensory deficits, and magnetic resonance imaging findings. The rAFM group was reliably defined by a case description.

"Much work is needed to better diagnose, treat, and prevent future cases of AFM," the authors write. "We have demonstrated here the need for stringent inclusion criteria to support future research efforts and propose a provisional case description to meet this need."

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