Comparison of acute flaccid myelitis and transverse myelitis in children and evaluation of diagnostic criteria

2016 Enterovirus D68 Acute Flaccid Myelitis Working Group and the Dutch Study Group for Pediatric Multiple Sclerosis and Acute Disseminated Encephalomyelitis, Jelte Helfferich*, Arlette L Bruijstens, Marjolein Knoester, Oebele F Brouwer, Rinze F Neuteboom

*Corresponding author for this work

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    BACKGROUND AND PURPOSE: Acute flaccid myelitis (AFM) and transverse myelitis (TM) are serious conditions that may be difficult to differentiate, especially at onset of disease. In this study, we compared clinical features of pediatric AFM and TM and evaluated current diagnostic criteria, aiming to improve early and accurate diagnosis.

    METHODS: Two cohorts of children with enterovirus D68-associated AFM and clinically diagnosed TM were compared regarding presenting clinical features, additional investigations, and outcome. Current diagnostic criteria for AFM and TM were applied to evaluate their specificity.

    RESULTS: Children with AFM (n = 21) compared to those with TM (n = 36) were younger (median 3 vs. 10 years), more often had a prodromal illness (100% vs. 39%), predominant proximal weakness (69% vs. 17%), and hyporeflexia (100% vs. 44%), and less often had sensory deficits (0% vs. 81%), bowel and/or bladder dysfunction (12% vs. 69%), and hyperreflexia (0% vs. 44%). On magnetic resonance imaging, brainstem involvement was more common in AFM (74% vs. 21%), whereas supratentorial abnormalities were only seen in TM (0% vs. 40%). When omitting the criterion of a sensory level, 11 of 15 (73%) children with AFM fulfilled the diagnostic criteria for TM. Of children with TM, four of 33 (12%) fulfilled the diagnostic criteria for probable/definite AFM.

    CONCLUSIONS: Although there is considerable overlap between AFM and TM in children, we found important early differentiating clinical and diagnostic features. Meeting diagnostic criteria for AFM in children with TM and vice versa underlines the importance of thorough clinical examination and early and accurate diagnostic studies.

    Original languageEnglish
    Pages (from-to)2430-2441
    Number of pages12
    JournalEuropean Journal of Neurology
    Issue number8
    Publication statusPublished - Aug-2023


    • Child
    • Humans
    • Myelitis, Transverse/diagnosis
    • Enterovirus Infections/complications
    • Neuromuscular Diseases/diagnosis
    • Myelitis/diagnosis
    • Central Nervous System Viral Diseases/diagnosis

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