Three-year longitudinal motor function and disability level of acute flaccid myelitis

Abstract Background We summarize the long-term motor outcome and disability level in a cluster of pediatric patients with acute flaccid myelitis (AFM) associated with the enterovirus D68 (EV-D68) outbreak in 2015. Methods This is a nationwide follow-up questionnaire analysis study. Clinical data including the motor function (manual muscle strength test) and other neurological symptoms were collected at the acute (nadir), recovery (6 months) and chronic (3 years) stages. We use the Barthel index which measures ten variables describing activity of daily living and mobility to assess the disability level. Results Clinical data of 33 patients with AFM (13 females, 20 males; median age=4.1 years) were available. Among patients with tetraplegia or triplegia, paraplegia, and monoplegia at the acute stage, 2/7, 4/13, and 2/13 exhibited complete recovery without paralysis, out of those 5/7, 8/13, and 2/13 who showed improvement with lesser limb involvement at the chronic stage, respectively. Nine patients (27%) demonstrated improvement at the recovery-to-chronic period. All six patients with positive isolation of EV-D68 from biological samples at the acute stage showed persistent motor deficits. Other neurological findings had better prognosis than motor weakness. Better Barthel index score at the chronic stage was observed [p Conclusions AFM has a high rate of persistent motor deficits showing 1–2 limb paralysis. Disability level of patients with AFM, however, generally improved at the 3-year time point.