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Comment & Response
May 28, 2019

Description of Restrictively Defined Acute Flaccid Myelitis

Author Affiliations
  • 1Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka, Japan
  • 2Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
JAMA Pediatr. 2019;173(7):702. doi:10.1001/jamapediatrics.2019.1269

To the Editor We read with great interest the retrospective case analysis by Elrick et al1 titled “Clinical Subpopulations in a Sample of North American Children Diagnosed With Acute Flaccid Myelitis, 2012-2016” regarding the definition of more specific diagnostic criteria for acute flaccid myelitis (AFM). We concur with the authors in that the standardized case definition of AFM as adopted by the US Centers for Disease Control and Prevention after the 2014 epidemic2 is appropriately sensitive in capturing possible AFM cases for epidemiologic surveillance. However, other neurologic entities that cause acute limb weakness, such as Guillain-Barré syndrome, transverse myelitis, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorders, and others, are not readily distinguishable from AFM using the current case definition. Thus, the authors propose a strict case description of “restrictively defined AFM” in an attempt to describe a subset of AFM with clinical features resembling classical poliomyelitis. The presence of infectious prodrome and 5 exclusion criteria are newly added to the original case definition.1

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