170 - Acute Flaccid Myelitis: Patient Characteristics and Prospective Follow-up Study at Children's National Hospital, 2013-2019

Background: Acute Flaccid Myelitis (AFM), diagnosed almost exclusively in children, is characterized by sudden onset flaccid weakness in one or more extremities with distinct gray matter spinal cord lesions on magnetic resonance imaging (MRI), with or without cerebrospinal fluid (CSF) pleocytosis. Outbreaks of AFM have occurred biennially since 2014.  Although the definitive causative agent(s) remain unknown, current data support an association with Enteroviruses D68 and A71. Treatment is supportive and long-term prognosis is variable, with many children having persistent motor deficits.

Methods: In this prospective cohort study, we identified patients with clinical and radiographic presentation consistent with AFM at Children’s National Hospital (CNH) from 2013-2019. Medical records and  MRIs of identified patients were then reviewed by members of the multidisciplinary CNH AFM Task Force to identify those meeting diagnostic criteria for AFM . Identified patients had follow-up arranged in the multidisciplinary AFM clinic for exam, functional motor assessment and quality of life questionnaires (Peds QL, PROMIS and NeuroQoL).
 
 

 
 

Results: Since 2013, we identified 22 patients meeting criteria for AFM at CNH. The average age of our patients was 7.25 years (range 6 months to 16 years);  almost 2/3 of patients had CSF pleocytosis. Half of patients presented with initial neurologic complaint of single limb weakness.  Other presenting neurological symptoms included ataxia, bilateral lower extremity weakness and ophthalmoplegia. A potential infectious cause was identified in the CSF, blood, nasopharynx or stool of 9 patients. As of November 2019, 7 of 21 patients have had follow-up evaluation;  1 had no improvement, 4 had partial improvement but with persistent motor deficits, and 2 had complete resolution. Two patients/families have completed quality of life questionnaires to date.CNH AFM Patient Characteristics and Results


Conclusion: Similar to other centers, the majority of CNH AFM patients with follow-up to date have persistent and significant long term motor deficits.  Assessment of quality of life is an important aspect that has not yet been formally assessed in other studies and will provide useful information regarding the experience of these patients and help identify goals for optimizing care in the future.

Presenting Author(s)

• 

  Alexandra B. Yonts, MD

  Pediatric Infectious Diseases Physician
  Children's National Hospital
  Silver Spring, MD

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• 

  Nada Harik, MD

  Associate Professor
  Children’s National Health System
  Washington, District of Columbia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AD

  Alyssa Doslea, MS

  Research Coordinator
  Children's National Hospital
  Washington, District of Columbia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JM

  Jonathan Murnick, MD, PhD

  Assistant Professor, Dept of Radiology and Pediatrics
  Children's National Hospital
  Washington, District of Columbia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JC

  Jessica Carpenter, MD

  Associate Professor, Department Neurology and Pediatrics
  Children's National Hospital
  Washington, District of Columbia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EW

  Elizabeth Wells, MD

  Associate Professor, Department of Neurology and Pediatrics
  Children's National Hospital
  Washington, District of Columbia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Roberta L. DeBiasi, MD, MS

  Chief, Pediatric ID and Professor, Pediatrics & Microbiology, Immunology, Tropical Medicine
  Children’s National Health System/ George Washington Univ School of Medicine
  Washington, District of Columbia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.