Jan A Martin1, Kevin Messacar1, Michele L Yang1, John A Maloney1, Jennifer Lindwall1, Terri Carry1, Patricia Kenyon1, Stefan H Sillau1, Joyce Oleszek1, Kenneth L Tyler1, Samuel R Dominguez1, Teri L Schreiner2. 1. From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine. 2. From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine. Teri.Schreiner@ucdenver.edu.
Abstract
OBJECTIVE: We describe long-term functional, neurodiagnostic, and psychosocial outcomes of a cohort of 12 children from Colorado diagnosed with acute flaccid myelitis (AFM) in 2014. METHODS: Children were assessed every 3 months for 1 year or until clinical resolution. Assessments included neurologic examination, MRI, EMG/nerve conduction studies (NCS), functional measures (Assisting Hand Assessment, Hammersmith Functional Motor Scale), and Patient-Reported Outcomes Measurement Information System questionnaires. RESULTS: Eight of 12 children completed the study. Six of 8 had persistent motor deficits at 1 year; 2 demonstrated full recovery. Four were not enrolled, 2 of whom reported full recovery. The 6 affected were weakest in proximal muscles, showing minimal to no improvement and significant atrophy at 1 year. All patients improved in distal muscle groups. Cranial nerve dysfunction resolved in 2 of 5 and improved in all. Four of 5 showed progressive functional improvement at 6 and 12 months. Two of 8 reported pain at 1 year. Three of 8 reported depressive symptoms. Repeat MRI was performed in 7 of 8 children a median of 7 months after onset and showed significant improvement or normalization in all but one child. Repeat EMG/NCS was performed on 4 children a median of 8 months after onset and showed ongoing denervation and chronic reinnervation in 3 children with persistent deficits. CONCLUSIONS: At 1 year, children with AFM demonstrated functional gains but weakness persisted. EMG changes correlated with persistent deficits better than imaging. Despite improvements, AFM had substantial long-term functional effects on affected children.
OBJECTIVE: We describe long-term functional, neurodiagnostic, and psychosocial outcomes of a cohort of 12 children from Colorado diagnosed with acute flaccid myelitis (AFM) in 2014. METHODS:Children were assessed every 3 months for 1 year or until clinical resolution. Assessments included neurologic examination, MRI, EMG/nerve conduction studies (NCS), functional measures (Assisting Hand Assessment, Hammersmith Functional Motor Scale), and Patient-Reported Outcomes Measurement Information System questionnaires. RESULTS: Eight of 12 children completed the study. Six of 8 had persistent motor deficits at 1 year; 2 demonstrated full recovery. Four were not enrolled, 2 of whom reported full recovery. The 6 affected were weakest in proximal muscles, showing minimal to no improvement and significant atrophy at 1 year. All patients improved in distal muscle groups. Cranial nerve dysfunction resolved in 2 of 5 and improved in all. Four of 5 showed progressive functional improvement at 6 and 12 months. Two of 8 reported pain at 1 year. Three of 8 reported depressive symptoms. Repeat MRI was performed in 7 of 8 children a median of 7 months after onset and showed significant improvement or normalization in all but one child. Repeat EMG/NCS was performed on 4 children a median of 8 months after onset and showed ongoing denervation and chronic reinnervation in 3 children with persistent deficits. CONCLUSIONS: At 1 year, children with AFM demonstrated functional gains but weakness persisted. EMG changes correlated with persistent deficits better than imaging. Despite improvements, AFM had substantial long-term functional effects on affected children.
Authors: Kevin Messacar; Stephen M M Hawkins; Joyce Baker; Kelly Pearce; Suhong Tong; Samuel R Dominguez; Sarah Parker Journal: JAMA Pediatr Date: 2016-03 Impact factor: 16.193
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Keith Van Haren; Patrick Ayscue; Emmanuelle Waubant; Anna Clayton; Heather Sheriff; Shigeo Yagi; Rose Glenn-Finer; Tasha Padilla; Jonathan B Strober; Grace Aldrovandi; Debra A Wadford; Charles Y Chiu; Dongxiang Xia; Kathleen Harriman; James P Watt; Carol A Glaser Journal: JAMA Date: 2015 Dec 22-29 Impact factor: 56.272
Authors: James J Sejvar; Adriana S Lopez; Margaret M Cortese; Eyal Leshem; Daniel M Pastula; Lisa Miller; Carol Glaser; Anita Kambhampati; Kayoko Shioda; Negar Aliabadi; Marc Fischer; Nicole Gregoricus; Robert Lanciotti; W Allan Nix; Senthilkumar K Sakthivel; D Scott Schmid; Jane F Seward; Suxiang Tong; M Steven Oberste; Mark Pallansch; Daniel Feikin Journal: Clin Infect Dis Date: 2016-06-17 Impact factor: 9.079
Authors: Negar Aliabadi; Kevin Messacar; Daniel M Pastula; Christine C Robinson; Eyal Leshem; James J Sejvar; W Allan Nix; M Steven Oberste; Daniel R Feikin; Samuel R Dominguez Journal: Emerg Infect Dis Date: 2016-08 Impact factor: 6.883
Authors: Matthew J Elrick; Eliza Gordon-Lipkin; Thomas O Crawford; Keith Van Haren; Kevin Messacar; Nicole Thornton; Elizabeth Dee; Annie Voskertchian; Jessica R Nance; Laura S Muñoz; Mark P Gorman; Leslie A Benson; David L Thomas; Carlos A Pardo; Aaron M Milstone; Priya Duggal Journal: JAMA Pediatr Date: 2019-02-01 Impact factor: 16.193
Authors: Divyanshu Dubey; Sean J Pittock; Karl N Krecke; Padraig P Morris; Elia Sechi; Nicholas L Zalewski; Brian G Weinshenker; Eslam Shosha; Claudia F Lucchinetti; James P Fryer; A Sebastian Lopez-Chiriboga; John C Chen; Jiraporn Jitprapaikulsan; Andrew McKeon; Avi Gadoth; B Mark Keegan; Jan-Mendelt Tillema; Elie Naddaf; Marc C Patterson; Kevin Messacar; Kenneth L Tyler; Eoin P Flanagan Journal: JAMA Neurol Date: 2019-03-01 Impact factor: 18.302
Authors: Kevin Messacar; Edwin J Asturias; Alison M Hixon; Coretta Van Leer-Buter; Hubert G M Niesters; Kenneth L Tyler; Mark J Abzug; Samuel R Dominguez Journal: Lancet Infect Dis Date: 2018-02-23 Impact factor: 25.071
Authors: P Texakalidis; D Xenos; N K Murthy; C L Karras; S J Trybula; M Behbahani; M G DeCuypere; S K Lam; T D Alden Journal: Childs Nerv Syst Date: 2022-01-04 Impact factor: 1.475
Authors: Kevin Messacar; Stefan Sillau; Sarah E Hopkins; Catherine Otten; Molly Wilson-Murphy; Brian Wong; Jonathan D Santoro; Andrew Treister; Harlori K Bains; Alcy Torres; Luke Zabrocki; Julia R Glanternik; Amanda L Hurst; Jan A Martin; Teri Schreiner; Naila Makhani; Roberta L DeBiasi; Michael C Kruer; Adriana H Tremoulet; Keith Van Haren; Jay Desai; Leslie A Benson; Mark P Gorman; Mark J Abzug; Kenneth L Tyler; Samuel R Dominguez Journal: Neurology Date: 2018-11-09 Impact factor: 9.910
Authors: Olwen C Murphy; Kevin Messacar; Leslie Benson; Riley Bove; Jessica L Carpenter; Thomas Crawford; Janet Dean; Roberta DeBiasi; Jay Desai; Matthew J Elrick; Raquel Farias-Moeller; Grace Y Gombolay; Benjamin Greenberg; Matthew Harmelink; Sue Hong; Sarah E Hopkins; Joyce Oleszek; Catherine Otten; Cristina L Sadowsky; Teri L Schreiner; Kiran T Thakur; Keith Van Haren; Carolina M Carballo; Pin Fee Chong; Amary Fall; Vykuntaraju K Gowda; Jelte Helfferich; Ryutaro Kira; Ming Lim; Eduardo L Lopez; Elizabeth M Wells; E Ann Yeh; Carlos A Pardo Journal: Lancet Date: 2020-12-23 Impact factor: 79.321