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 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 (six months), and chronic (three years) stages. We use the Barthel index, which measures 10 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, two of seven, four of thirteen, and two of thirteen exhibited complete recovery without paralysis; of those five of seven, eight of thirteen, and two of thirteen 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 enterovirus 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 < 0.001; median difference [95% confidence interval], 53 [40 to 63]), implying an improved disability level even in patients with persistent motor deficits.

Conclusions

AFM has a high rate of persistent motor deficits showing one- to two-limb paralysis. Disability level of patients with AFM, however, generally improved at the three-year time point.

中文翻译：

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急性弛缓性脊髓炎三年纵向运动功能及残疾程度

背景

我们总结了 2015 年与肠道病毒 D68 爆发相关的一组急性弛缓性脊髓炎 (AFM) 儿科患者的长期运动结果和残疾水平。

方法

这是一项全国性的随访问卷分析研究。在急性（最低点）、恢复（六个月）和慢性（三年）阶段收集包括运动功能（手动肌肉力量测试）和其他神经系统症状在内的临床数据。我们使用 Barthel 指数衡量 10 个描述日常生活活动和活动能力的变量来评估残疾程度。

结果

可获得 33 名 AFM 患者（13 名女性，20 名男性；中位年龄 = 4.1 岁）的临床数据。在急性期四肢瘫痪或三肢瘫痪、截瘫和单瘫的患者中，7 人中有 2 人、13 人中有 4 人、13 人中有 2 人完全康复，没有瘫痪；在这 7 人中的 5 人中，13 人中的 8 人和 13 人中的 2 人在慢性期分别表现出改善，肢体受累较少。九名患者（27%）在慢性恢复期表现出改善。在急性期从生物样本中分离出肠道病毒 D68 阳性的所有 6 名患者均表现出持续的运动障碍。其他神经系统发现比运动无力具有更好的预后。在慢性期观察到更好的 Barthel 指数评分（P < 0.001; 中位数差异 [95% 置信区间]，53 [40 至 63]），这意味着即使在持续运动缺陷的患者中，残疾水平也有所改善。

结论

AFM 具有很高的持续运动缺陷率，表现为一到两肢瘫痪。然而，AFM 患者的残疾水平在三年时间点普遍得到改善。