Treatment of acute flaccid myelitis in children should be individualized

Corticosteroids can be a safe option for children and adolescents with acute flaccid myelitis (AFM), but therapy choice should be made on a case-by-case basis, as corticosteroids can worsen viral infections in the spinal cord, according to results published in BMJ Neurology Open .

The CAPTURE Study ( Identifier: NCT02144935) was a prospective observational cohort study that included data from children and adolescents (ages 0-17 years) with myelitis from academic centers with experience of the disease. The study researchers classified the patients as either patients with transverse myelitis (TM; n = 39) or AFM (n = 51). The study, which ran for 5 years, followed patients for a period of one year after the onset of the disease.

The results of magnetic resonance imaging showed that a significantly larger proportion of patients with AFM had a lesion related to C4 compared to patients with TM (68% and 43.2%; odds ratio.) [OR], 0.36; 95% CI, 0.14-0.94; P = .03).

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In the group of patients with AFM, the study researchers found indications of 2 clinically relevant patterns: a form of AFM restricted to the gray matter and a group with simultaneous white matter. The white matter reportedly explained the lower extremity motor deficits in the cohort of patients with lesions only in the cervical spine.

All patients in the study received either corticosteroids or intravenous immunoglobulin as first-line therapy. The study results showed no evidence to suggest that first-line intravenous immunoglobulin resulted in greater improvements compared to corticosteroids (P = 0.89). The use of corticosteroids did not improve these deficits significantly better in the AFM cohort than in the group of patients with TM (P = 0.97).

The limitations of this study were the non-randomized nature and the lack of data on patient compliance.

The study’s researchers concluded that more “prospective studies need to be continued and expanded to develop validated treatment algorithms for this growing public health problem”.


Greenberg B, Plumb P, Cutter G, et al. Acute Flaccid Myelitis: Long-Term Results Recorded in the CAPTURE Study Compared to Pediatric Transverse Myelitis. BMJ Neurol Open. 2021; 3 (1): e000127. doi: 10.1136 / bmjno-2021-000127

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