Division of Pediatric Neurology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey.
Division of Pediatric Neurology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey.
Eur J Paediatr Neurol. 2021 Jan;30:113-120. doi: 10.1016/j.ejpn.2020.10.011. Epub 2020 Nov 4.
We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis.
The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed.
Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5-6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3-7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis.
The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition.
描述急性弛缓性脊髓炎的人口统计学特征、病因、神经生理学、影像学表现、治疗、预后和预后因素。
回顾 2016 年 8 月 1 日至 2018 年 12 月 31 日期间，土耳其 13 个中心根据疾病控制中心标准诊断为急性弛缓性脊髓炎的儿科患者的临床数据、实验室检查和磁共振成像（MRI）结果。
共发现 34 例，其中 31 例确诊（91.2%）。18 例（55.9%）为男性。中位患者年龄为 4 岁（四分位距 2.5-6.9 岁）。大多数患者于 2018 年入院（n=27）。所有患者均有发热性疾病前驱史，症状前中位时间为 4 天（四分位距 3-7 天）。31 例患者的脊髓 MRI 显示 T2 高信号，18 例患者的脑脊液有细胞增多。呼吸道标本中最常见的感染病原体是肠/鼻病毒（n=5）。除 1 例患者外，所有患者均接受免疫治疗，或单独使用，或联合使用。27 例有随访数据的患者中，24 例持续存在肌无力。发病时四肢同时受累和异常脑 MRI 与预后不良相关。
自 2012 年以来，急性弛缓性脊髓炎的患者数量增加，每隔 2 年出现一次高峰，主要发生在儿科人群中。每次暴发的中位年龄都在下降。临床医生应注意该病的临床表现，以便早期采集标本和开始康复计划。需要进一步研究以更好地描述这种罕见疾病的病因、发病机制、危险因素和治疗方法。
