Key result
Spontaneous functional limb recovery (≥M3) occurred in 43% of upper extremities within 3 months of acute flaccid myelitis onset, with extraplexal paralysis correlating with decreased recovery.
Why the study?
Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis were unknown.
What are the clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis?
Observational (n=22)
No
What are the clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis?
Spontaneous functional limb recovery in acute flaccid myelitis occurs early (within 3 months), suggesting that patients without early recovery should be considered for early surgical intervention.
Pediatric AFM recovery data remain retrospective and limited; leaves open optimal nonsurgical timing and hand surgery referral criteria.
BACKGROUND: Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis are unknown. METHODS: A single-institution retrospective case series was analyzed to describe clinical features of acute flaccid myelitis diagnosed between October of 2013 and December of 2016. Patients were consecutively sampled children with a diagnosis of acute flaccid myelitis who were referred to a hand surgeon. Patient factors and initial severity of paralysis were compared with upper extremity muscle strength outcomes using the Medical Research Council scale every 3 months up to 18 months after onset. RESULTS: Twenty-two patients with acute flaccid myelitis (aged 2 to 16 years) were studied. Proximal upper extremity musculature was more frequently and severely affected, with 56 percent of patients affected bilaterally. Functional recovery of all muscle groups (≥M3) in an individual limb was observed in 43 percent of upper extremities within 3 months. Additional complete limb recovery to greater than or equal to M3 after 3 months was rarely observed. Extraplexal paralysis, including spinal accessory (72 percent), glossopharyngeal/hypoglossal (28 percent), lower extremity (28 percent), facial (22 percent), and phrenic nerves (17 percent), was correlated with greater severity of upper extremity paralysis and decreased spontaneous recovery. There was no correlation between severity of paralysis or recovery and patient characteristics, including age, sex, comorbidities, prodromal symptoms, or time to paralysis. CONCLUSIONS: Spontaneous functional limb recovery, if present, occurred early, within 3 months of the onset of paralysis. The authors recommend that patients without signs of early recovery warrant consideration for early surgical intervention and referral to a hand surgeon or other specialist in peripheral nerve injury. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
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Weber et al. (2020) conducted an observational in Acute flaccid myelitis (n=22). Nonsurgical management was evaluated on Functional recovery of all muscle groups (≥M3) in an individual limb within 3 months. Spontaneous functional limb recovery (≥M3) occurred in 43% of upper extremities within 3 months of acute flaccid myelitis onset, with extraplexal paralysis correlating with decreased recovery.
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