Clinical profile of acute flaccid paralysis: A study from North India, Kashmir

Background and Aims: As a part of Global Polio Eradication Programme by the World Health Organization, 1988 surveillance of acute flaccid paralysis (AFP) was an important public health activity in many countries. With nearing the eradication of poliomyelitis, other causes of AFP are gaining importance in both children and adults. This study was designed to know the clinical characteristics, and differential diagnosis of causes of AFP, including distribution by age, gender, and time. This was a prospective observational study. Methods: AFP cases were diagnosed on the basis of history and physical examination. The underlying etiology was ascertained by appropriate laboratory investigations such as arterial blood gas analysis, urinary pH, electrolytes, thyroid profile, electrophysiological studies, cerebrospinal fluid analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled. Out of 106 patients, 58 (54.7%) were suffering from Guillain-Barrι syndrome (GBS), 15 (14.2%) from hypokalemic paralysis, 8 (7.5%) from myasthenia gravis, 8 (7.5%) from thiamine deficiency, 5 (4.7%) from transverse myelitis, and 2 (1.9%) from cord compression. Other diagnoses include; acute motor axonal neuropathy 3 (2.8%), acute disseminated encephalomyelitis 2 (1.9%), meningoencephalitis 2 (1.9%), diabetic polyneuropathy 2 (1.9%), and chemotherapy-induced neuropathy 1 (0.9%). Most cases, 42/106 (39.6%) were admitted during the spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most of the AFP cases occurred during the spring season. No case of poliomyelitis was found.