Treatment for Pediatric Acute Flaccid Myelitis Should Be Individualized

Study researchers conducted a prospective, multicenter study to evaluate outcomes in pediatric myelitis patients relative to their treatments.

Corticosteroids may be a safe option for children and adolescents with acute flaccid myelitis (AFM), but choice of therapy should be made on a case-by-case basis, considering corticosteroids may lead to worsening viral infections within the spinal cord, according to study findings published in BMJ Neurology Open.

The CAPTURE study ( Identifier: NCT02144935) was a prospective, observational cohort study which included data of children and adolescents (age range, 0 to 17 years) with myelitis from academic centers with expertise in the condition. Study researchers classified patients as having either transverse myelitis (TM; n=39) or AFM (n=51). The study, which ran for 5 years, followed patients through a 1-year period after disease onset.

Findings from magnetic resonance imaging showed a significantly greater proportion of patients with AFM had a lesion involved in C4 compared with patients with TM (68% vs 43.2%, respectively; odds ratio [OR], 0.36; 95% CI, 0.14-0.94; P =.03).

In the group of patients with AFM, the study researchers found evidence of 2 clinically relevant patterns: a gray-matter restricted form of AFM as well as a group with concomitant 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 their first-line therapy. Study findings indicated no evidence to support the notion first-line intravenous immunoglobulin led to greater improvements compared with corticosteroids (P =.89). The use of corticosteroids did not significantly improve these deficits in the AFM cohort better than that reported in the group of patients with TM (P =.97).

Limitations of this study included its nonrandomized nature as well as the lack of data on patients’ treatment adherence.

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


Greenberg B, Plumb P, Cutter G, et al. Acute flaccid myelitis: long-term outcomes recorded in the CAPTURE study compared with paediatric transverse myelitis. BMJ Neurol Open. 2021;3(1):e000127. doi:10.1136/bmjno-2021-000127