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Acute Flaccid Myelitis

Acute Flaccid Myelitis (AFM) — Comprehensive Disease Characteristics Report

2026-05-16
Falcon MONDO:0100115 Model: Edison Scientific Literature 39 citations

Acute Flaccid Myelitis (AFM) — Comprehensive Disease Characteristics Report

Target disease: Acute flaccid myelitis (AFM)

Summary (current understanding): AFM is a rare, severe neurologic syndrome (often pediatric) characterized by acute flaccid limb weakness with spinal cord gray-matter–predominant lesions on MRI, clinically resembling poliomyelitis. In the United States, AFM incidence showed large peaks in 2014/2016/2018 and remained lower in 2019–2022, despite renewed EV-D68 circulation in 2022 without a commensurate AFM surge, emphasizing unresolved determinants of neuroinvasion and paralytic risk. (whitehouse2024surveillanceforacute pages 1-2, kidd2020vitalsignsclinical pages 1-2, messacar2024multimodalsurveillancemodel pages 3-5)

1. Disease Information

1.1 Disease overview and definition

CDC surveillance definitions used in recent U.S. reports define confirmed AFM as acute flaccid limb weakness with MRI demonstrating a spinal cord lesion largely restricted to gray matter spanning ≥1 vertebral segment. (whitehouse2024surveillanceforacute pages 1-2, kidd2020vitalsignsclinical pages 1-2)

A recent European case report restates the CDC framing as “an acute-onset flaccid weakness of one or more limbs” with MRI evidence of gray-matter involvement and no clear alternative diagnosis. (rodesch2024afirstcase pages 1-3)

1.2 Key identifiers

  • MONDO ID: Not available from the retrieved evidence set (not found in the sources accessed for this report).
  • ICD/MeSH/Orphanet/OMIM: Not available from the retrieved evidence set.

1.3 Synonyms and alternative names

1.4 Evidence source type (individual vs aggregated)

This report integrates both: * Aggregated public-health surveillance/clinical series (CDC MMWR surveillance; Colorado multimodal surveillance; surgical cohort; rehabilitation case series). (whitehouse2024surveillanceforacute pages 1-2, messacar2024multimodalsurveillancemodel pages 3-5, doi2024midtermoutcomesof pages 1-2, neighbors2024transcutaneousspinalcord pages 5-8) * Individual patient-level case report (Belgium EV-D68-associated AFM). (rodesch2024afirstcase pages 1-3)

2. Etiology

2.1 Disease causal factors

Infectious association (dominant current model): AFM is strongly associated with non-polio enteroviruses, particularly enterovirus D68 (EV-D68), based on epidemiologic correlation with outbreak years and frequent detection in non-sterile sites (especially respiratory specimens), while pathogen detection in CSF is uncommon. (murphy2021acuteflaccidmyelitis pages 1-2, kidd2020vitalsignsclinical pages 1-2, whitehouse2024surveillanceforacute pages 1-2)

CDC surveillance indicates that AFM peaks (2014/2016/2018) were linked to EV-D68 circulation, while post-2018 counts remained low; reasons remain uncertain. (whitehouse2024surveillanceforacute pages 1-2)

Multi-pathogen reality: Non–EV-D68 enteroviruses have also been identified in confirmed AFM patients (e.g., EV-A71 and other enteroviruses/echoviruses/cox­sackie types), and coinfections can occur. (whitehouse2024surveillanceforacute pages 5-6, whitehouse2024surveillanceforacute pages 6-7)

2.2 Risk factors (supported by recent surveillance)

2.3 Protective factors

No validated genetic or environmental protective factors were identified in the retrieved evidence set.

2.4 Gene–environment interactions

No specific, reproducible gene–environment interaction evidence was identified in the retrieved evidence set.

3. Phenotypes

3.1 Core neurologic phenotype

Acute limb weakness/paralysis is the defining clinical phenotype. CDC describes AFM as “characterized by the acute onset of limb weakness or paralysis.” (kidd2020vitalsignsclinical pages 1-2)

Distribution of weakness varies by outbreak year: In the U.S. 2018 peak year, upper limb involvement was common (84%), while later years showed relatively more lower limb involvement and lower rates of classic peak-year features. (whitehouse2024surveillanceforacute pages 4-5, whitehouse2024surveillanceforacute pages 1-2)

3.2 Common symptoms/signs during evaluation (example: U.S. 2018)

In 2018 confirmed U.S. cases, common findings included: * Gait difficulty: 52% * Neck or back pain: 47% * Fever at evaluation: 35% * Limb pain: 34% (kidd2020vitalsignsclinical pages 1-2)

3.3 Laboratory phenotype

CSF pleocytosis is common in peak-year AFM, with year-to-year variation; CDC surveillance reports CSF pleocytosis of 87% in 2018 (183/210) versus 42–49% in 2019–2021 and 68% in 2022 (28/41). (whitehouse2024surveillanceforacute pages 4-5)

3.4 Quality-of-life impact

AFM is associated with high morbidity and incomplete neurologic recovery, with long-term disability common in clinical reviews and cohort summaries. (murphy2021acuteflaccidmyelitis pages 1-2, vawterlee2021acuteflaccidmyelitis pages 2-3)

3.5 Suggested HPO terms (candidate mappings)

The retrieved evidence supports, at minimum: * Acute flaccid paralysis / acute limb weakness (HP:0002015 or conceptually similar) * Gait disturbance (HP:0001288) * Neck pain / back pain (HP:0000467 / HP:0003418) * Respiratory failure / need for mechanical ventilation (HP:0002878) * CSF pleocytosis (HP:0002180)

(Note: HPO identifiers are provided as common standard mappings; confirm exact HPO IDs/labels in the current HPO release before database ingestion.)

4. Genetic/Molecular Information

4.1 Causal genes / pathogenic variants

AFM is not established as a monogenic disorder in the retrieved evidence set; the dominant evidence supports an infectious-triggered neuroinflammatory/anterior horn cell injury syndrome rather than a single-gene etiology. (murphy2021acuteflaccidmyelitis pages 1-2)

4.2 Modifier genes / host susceptibility

No specific host genetic modifiers were identified in the retrieved evidence set.

4.3 Epigenetics / chromosomal abnormalities

No AFM-specific epigenetic or chromosomal-abnormality evidence was identified in the retrieved evidence set.

5. Environmental Information

5.1 Infectious agents (primary environmental exposure)

Enteroviruses, particularly EV-D68, are the best-supported associated infectious agents across surveillance and mechanistic modeling. (whitehouse2024surveillanceforacute pages 1-2, kidd2020vitalsignsclinical pages 1-2, aguglia2023contemporaryenterovirusd68isolates pages 1-2)

5.2 Other environmental/lifestyle factors

No toxin/radiation/pollution or lifestyle risk factor evidence was identified in the retrieved evidence set.

6. Mechanism / Pathophysiology

6.1 Current mechanistic model (causal chain)

1) Preceding viral illness (often respiratory/febrile) occurs days before neurologic onset in many peak-year cases. (kidd2020vitalsignsclinical pages 1-2) 2) Neurotropic infection and/or immune-mediated injury targets spinal cord gray matter (anterior horn/motor neuron regions), producing the MRI signature and motor deficits. (whitehouse2024surveillanceforacute pages 1-2, aguglia2023contemporaryenterovirusd68isolates pages 1-2) 3) Secondary immune-mediated injury is likely important: Human spinal cord organoid data show sustained EV-D68 infection with limited cytopathic effects, implying that infection alone may not explain neuronal loss in vivo.

6.2 Human spinal cord organoid evidence (recent development)

Aguglia et al. (mBio, 2023-08) emphasize the need for human CNS models because “humans are the only natural hosts for enterovirus infections” and enteroviruses “do not routinely infect other animal species.” (aguglia2023contemporaryenterovirusd68isolates pages 1-2, aguglia2023contemporaryenterovirusd68isolates pages 5-8)

Key findings from the organoid model: * Strain specificity: Contemporary (post-2014) EV-D68 isolates infect spinal cord organoids, whereas a historic strain (Fermon) does not productively infect. (aguglia2023contemporaryenterovirusd68isolates pages 2-5, aguglia2023contemporaryenterovirusd68isolates pages 5-8) * Persistence without marked lysis: Infected organoids “produce extracellular virus for at least 2 weeks without appreciable cytopathic effect” and maintain morphology, with less apoptosis than a comparator enterovirus (echovirus 11). (aguglia2023contemporaryenterovirusd68isolates pages 1-2, aguglia2023contemporaryenterovirusd68isolates pages 8-10) * Immune contribution hypothesis: The authors note that in vitro models lack migratory innate/adaptive immune cells and that this limitation may allow persistence without the injury patterns seen in vivo, supporting a role for immune-mediated secondary damage in AFM. (aguglia2023contemporaryenterovirusd68isolates pages 8-10, aguglia2023contemporaryenterovirusd68isolates pages 10-12)

6.3 Suggested ontology mappings

7. Anatomical Structures Affected

7.1 Organ/system level

7.2 Tissue/cell level

8. Temporal Development

8.1 Onset and course

8.2 Recovery window

Rehabilitation literature indicates recovery is often incomplete; functional gains are most robust in the first year but can continue to ~18 months, with persistent proximal weakness/atrophy common. (ide2021acuteflaccidmyelitis. pages 11-13)

9. Inheritance and Population

9.1 Epidemiology (recent statistics)

United States (CDC surveillance): * Confirmed AFM cases: 238 (2018); 47 (2019); 33 (2020); 28 (2021); 47 (2022). (whitehouse2024surveillanceforacute pages 1-2)

U.S. 2018 clinical severity: * 98% hospitalized, 54% ICU, 23% required intubation/mechanical ventilation. (kidd2020vitalsignsclinical pages 1-2)

Colorado 2022 (EV-D68 outbreak monitoring + AFM burden): * Among 529 EV/RV-positive respiratory specimens tested, 121 (22.9%) were EV-D68-positive, peaking at 78.6% weekly positivity in late August 2022. (messacar2024multimodalsurveillancemodel pages 3-5) * AFM remained uncommon during this EV-D68 respiratory outbreak (Colorado CDC-classified suspected AFM cases in 2022: 4, versus 17 in 2018). (messacar2024multimodalsurveillancemodel pages 5-7)

9.2 Sex ratio and geographic distribution

Not available from the retrieved evidence set.

10. Diagnostics

10.1 Diagnostic criteria (CDC-based)

10.2 Imaging findings

  • MRI hallmark: spinal cord gray-matter–predominant lesions, often longitudinally extensive early.
  • Example case (Belgium, EV-D68-associated): cervical cord central gray matter T2 hyperintensity (C2–C7) with posterior brainstem involvement. (rodesch2024afirstcase pages 1-3)

10.3 CSF and virologic testing

10.4 Electrodiagnostics (EMG/NCS)

Rehabilitation review describes a pattern consistent with motor neuronopathy/neuropathy with relative preservation of sensory conduction in most cases. (ide2021acuteflaccidmyelitis. pages 11-13)

10.5 Differential diagnosis

A complete differential is not enumerated in the retrieved evidence set; however, case and protocol literature emphasizes the need for prompt workup to distinguish AFM from other causes of acute flaccid paralysis. (rodesch2024afirstcase pages 1-3, vawterlee2021acuteflaccidmyelitis pages 2-3)

11. Outcome / Prognosis

11.1 Short-term severity (hospital course)

Across U.S. surveillance summaries (2018–2022), severe disease was frequent: ICU admission 54%, respiratory support 27%, mechanical ventilation 23%. (whitehouse2024surveillanceforacute pages 5-6)

11.2 Long-term disability and recovery

AFM frequently results in incomplete recovery and long-term sequelae (residual weakness, atrophy, and other neurological/musculoskeletal impacts), as summarized in a major clinical review. (murphy2021acuteflaccidmyelitis pages 1-2)

Case-level prognosis can be poor: the Belgium EV-D68-associated case had persistent proximal arm paresis with shoulder atrophy years later (as summarized in the report excerpt), and authors emphasize poor functional prognosis. (rodesch2024afirstcase pages 3-5)

11.3 Prognostic factor example (upper extremity)

In a surgical referral cohort, “none of the patients with M0 shoulder abduction at the 6-month evaluation recovered M1 or better”, supporting the use of 6-month post-onset strength as a decision point for surgical reconstruction consideration. (doi2024midtermoutcomesof pages 12-13, doi2024midtermoutcomesof pages 11-12)

12. Treatment

12.1 Acute pharmacologic/immunomodulatory therapies (current practice; evidence gaps)

CDC surveillance documents real-world use (not efficacy) of: * Steroids alone: 23% * IVIG alone: 23% * Steroids + IVIG: 34% * Plasma exchange (PLEX): 13% (whitehouse2024surveillanceforacute pages 5-6)

Case literature emphasizes absence of evidence-based guidelines and that management is largely supportive, with controversial corticosteroid use and variable IVIG response. (rodesch2024afirstcase pages 3-5)

Suggested MAXO terms (candidates): intravenous immunoglobulin therapy; therapeutic plasma exchange; systemic corticosteroid therapy; supportive respiratory care.

12.2 Rehabilitation and real-world implementations (including 2024 innovations)

Comprehensive rehabilitation is consistently emphasized as central to functional improvement and quality of life, even without proven disease-modifying therapy. (murphy2021acuteflaccidmyelitis pages 1-2, ide2021acuteflaccidmyelitis. pages 11-13)

2024 development—neuromodulation-assisted gait rehab: A 4-child case series used transcutaneous spinal cord stimulation (TSS) paired with intensive gait training (22 sessions over 5–8 weeks). Feasibility/safety: 98.48% session completion and no significant adverse events; walking endurance improved (6MWT increased by +98.3 m, +68 m, +9.4 m, +49.4 m; 3/4 exceeded MCID). (neighbors2024transcutaneousspinalcord pages 5-8, neighbors2024transcutaneousspinalcord pages 1-2)

Suggested MAXO terms (candidates): physical therapy; gait training; transcutaneous spinal cord stimulation; body-weight–supported treadmill training.

12.3 Surgical and interventional management

A 2024 cohort study reports nerve transfers, muscle/tendon transfers, and free muscle transfers for persistent deficits; elbow and hand reconstructions showed more consistent outcomes than shoulder reconstructions. (doi2024midtermoutcomesof pages 1-2)

Suggested MAXO terms (candidates): nerve transfer surgery; tendon transfer; free functional muscle transfer; orthopedic reconstruction.

12.4 Clinical trials / registries

NCT03499366 (ClinicalTrials.gov; first posted 2018-04-17; last update posted 2018-05-11): European pediatric AFM-EV-D68 follow-up study targeting ~40 participants with EV-D68 PCR positivity and MRI-confirmed myelitis, assessing functional outcomes including Hammersmith Functional Motor Scale at 1–3 years and secondary outcomes including ventilator/ICU days and quality of life. (NCT03499366 chunk 1)

13. Prevention

13.1 Primary prevention

No licensed EV-D68 vaccine or AFM-specific preventive therapy is supported in the retrieved evidence set; prevention is currently focused on public health surveillance/early warning and infection control during enterovirus circulation periods. (rodesch2024afirstcase pages 3-5, messacar2024multimodalsurveillancemodel pages 3-5)

13.2 Public health implementations (2024 evidence)

A 2024 Colorado program illustrates multimodal surveillance (syndromic ED asthma visits, EV-D68 RT-PCR confirmation, wastewater testing) enabling real-time preparedness actions including provider outreach and surge planning. (messacar2024multimodalsurveillancemodel pages 7-8, messacar2024multimodalsurveillancemodel pages 3-5)

14. Other Species / Natural Disease

No naturally occurring non-human AFM equivalent was identified in the retrieved evidence set.

15. Model Organisms

15.1 Human organoid models (high relevance to AFM)

Human spinal cord organoids provide a multicellular CNS model for EV-D68 neurotropism; contemporary EV-D68 strains infect and persist with modest cytopathic effect, supporting investigation of immune-mediated injury mechanisms and antiviral testing. (aguglia2023contemporaryenterovirusd68isolates pages 1-2, aguglia2023contemporaryenterovirusd68isolates pages 8-10)

15.2 Animal models (limited detail in retrieved evidence)

The organoid paper notes limitations of mouse models (often requiring neonatal or immunosuppressed mice, intracranial inoculation, or mouse-adapted viruses), reinforcing why complementary human models are needed. (aguglia2023contemporaryenterovirusd68isolates pages 1-2)

Key evidence table

Table (click to expand)
Topic/Section Key finding (with key numbers) Population/Setting Year Source (first author, journal) PMID if available URL
Surveillance / epidemiology U.S. confirmed AFM cases: 238 in 2018; then 47 (2019), 33 (2020), 28 (2021), 47 (2022). Confirmed AFM requires acute flaccid limb weakness plus MRI spinal cord lesion largely restricted to gray matter spanning ≥1 vertebral segment. 2018 cases were 94% aged <18 years; median age 5.3 years. ICU admission 54%, respiratory support 27%, mechanical ventilation 23%. EV-D68 detected in 37 cases in 2018; lower in later years. (whitehouse2024surveillanceforacute pages 1-2, whitehouse2024surveillanceforacute pages 5-6, whitehouse2024surveillanceforacute pages 4-5) United States national AFM surveillance, 2018–2022 2024 Whitehouse, MMWR https://www.cdc.gov/mmwr/volumes/73/ss/ss7304a1.htm
Clinical characteristics Among 238 confirmed AFM patients in 2018, median age was 5.3 years; 86% had onset during Aug–Nov; 92% had prodromal fever/respiratory illness beginning median 6 days before weakness; common findings: gait difficulty 52%, neck/back pain 47%, limb pain 34%; 98% hospitalized, 54% ICU, 23% intubated/mechanically ventilated. (kidd2020vitalsignsclinical pages 1-2) United States confirmed AFM patients during 2018 peak year 2020 Kidd, MMWR https://doi.org/10.15585/mmwr.mm6931e3
Recent surveillance development Multimodal Colorado EV-D68/AFM surveillance combined syndromic, clinical PCR, and wastewater data. From Jun 15–Nov 3, 2022, 529 EV/RV-positive respiratory specimens were tested and 121/529 (22.9%) were EV-D68-positive; peak weekly positivity 78.6% in late Aug 2022. Wastewater detection preceded the syndromic alarm by ~1 month/1–2 weeks depending on analytic layer. Colorado had 4 suspected AFM cases in 2022 versus 17 in 2018. (messacar2024multimodalsurveillancemodel pages 5-7, messacar2024multimodalsurveillancemodel pages 3-5, messacar2024multimodalsurveillancemodel pages 7-8) Colorado, USA pediatric hospital/public-health surveillance during 2022 EV-D68 outbreak 2024 Messacar, Emerging Infectious Diseases https://doi.org/10.3201/eid3003.231223
Etiology / overall review AFM is strongly associated with non-polio enteroviruses, especially EV-D68; direct virus detection in CSF is uncommon, but epidemiology, animal models, and CSF antibody studies support causality. Long-term recovery is often incomplete with residual weakness, atrophy, and neurologic/musculoskeletal sequelae; rehabilitation and selected nerve-transfer surgery may improve function. (murphy2021acuteflaccidmyelitis pages 1-2) International review of human clinical, laboratory, and model-organism evidence 2021 Murphy, The Lancet https://doi.org/10.1016/S0140-6736(20)32723-9
Rehabilitation / outcomes AFM rehab review notes electrodiagnostics usually show motor neuronopathy/neuropathy with preserved sensory conduction. Recovery is often poor; some series reported full recovery in only 10% or 41%. Greatest recovery generally occurs within 12 months, but gains may continue to 18 months. Supportive multidisciplinary rehab, ABRT, ventilatory management, diaphragmatic pacing, and nerve transfer surgery are discussed. (ide2021acuteflaccidmyelitis. pages 11-13) Rehabilitation literature and AFM cohorts, largely pediatric 2021 Ide, PM&R Clinics of North America https://doi.org/10.1016/j.pmr.2021.02.004
Novel rehabilitation intervention In a 4-patient pediatric case series, 22 sessions over 5–8 weeks of transcutaneous spinal cord stimulation (TSS) plus gait training were feasible and safe. Session completion was 98.48%; no significant adverse events. 6MWT improved by +98.3 m, +68 m, +9.4 m, and +49.4 m; 3/4 exceeded MCID. WISCI-II improved clinically in 2/4 participants. (neighbors2024transcutaneousspinalcord pages 3-5, neighbors2024transcutaneousspinalcord pages 5-8, neighbors2024transcutaneousspinalcord pages 1-2) Four children with incomplete SCI secondary to AFM 2024 Neighbors, Children https://doi.org/10.3390/children11091116
Surgical reconstruction / prognosis Retrospective cohort of 39 AFM patients (50 upper extremities). Recovery assessed at median 3, 6, and 37 months. Key prognostic result: none of the patients with M0 shoulder abduction at 6 months later recovered M1 or better. Twenty-seven patients (29 extremities) underwent reconstruction (nerve transfer, muscle-tendon transfer, free muscle transfer). Elbow/hand outcomes were more consistent than shoulder outcomes. (doi2024midtermoutcomesof pages 1-2, doi2024midtermoutcomesof pages 11-12, doi2024midtermoutcomesof pages 2-4) AFM upper-extremity paralysis, 2011–2019 surgical referral cohort 2024 Doi, JBJS Open Access https://doi.org/10.2106/JBJS.OA.23.00143
Case report / diagnostic illustration First reported Belgium AFM case linked to EV-D68: 4-year-old with acute right upper-limb palsy. MRI showed central gray matter T2 hyperintensity in cervical cord C2–C7 with posterior brainstem involvement; nasopharyngeal PCR positive for EV-D68; CSF enterovirus PCR negative. Authors note poor functional prognosis and no evidence-based treatment guideline. (rodesch2024afirstcase pages 3-5, rodesch2024afirstcase pages 1-3) Single pediatric case, Belgium 2024 Rodesch, Case Reports in Neurology https://doi.org/10.1159/000535316
Prospective follow-up study / trial registry ClinicalTrials.gov follow-up study of pediatric AFM associated with EV-D68 planned functional follow-up using Hammersmith Functional Motor Scale at 1–3 years; secondary outcomes include MRC scores, ACTIVLIM, PedsQL, ICU/mechanical ventilation duration, deaths, and complete recovery. Enrollment target 40; start date 2018-04-09. (NCT03499366 chunk 1) European children <18 years with AFM, EV-D68 PCR positivity, MRI-confirmed myelitis 2018 Pfeiffer, ClinicalTrials.gov (NCT03499366) https://clinicaltrials.gov/study/NCT03499366

Table: This table summarizes high-yield evidence on acute flaccid myelitis across surveillance, etiology, diagnostics, rehabilitation, surgery, and follow-up research. It is designed to support a disease knowledge base entry with recent statistics, clinically actionable findings, and source links.

Expert opinion / authoritative analysis (from retrieved sources)

Notes on evidence gaps (for knowledge base curation)

  • Ontology identifiers (MONDO/MeSH/Orphanet/OMIM/ICD-10/ICD-11): not retrievable from the current evidence set; recommended to supplement via MONDO/MeSH browsers and ICD crosswalks.
  • Genetic susceptibility/variants: not supported in retrieved sources; AFM currently best represented as a syndrome with infectious association and immune-mediated injury.
  • Differential diagnosis and biomarker specificity: only partially covered; additional guideline-level sources would be needed for a complete differential and test performance metrics.

References

  1. (whitehouse2024surveillanceforacute pages 1-2): ER Whitehouse. Surveillance for acute flaccid myelitis―united states, 2018–2022. Unknown journal, 2024.

  2. (kidd2020vitalsignsclinical pages 1-2): Sarah Kidd, Adriana Lopez, W. Allan Nix, Gloria Anyalechi, Megumi Itoh, Eileen Yee, M. Steven Oberste, and Janell Routh. Vital signs: clinical characteristics of patients with confirmed acute flaccid myelitis, united states, 2018. Morbidity and Mortality Weekly Report, 69:1031-1038, Aug 2020. URL: https://doi.org/10.15585/mmwr.mm6931e3, doi:10.15585/mmwr.mm6931e3. This article has 24 citations.

  3. (messacar2024multimodalsurveillancemodel pages 3-5): K. Messacar, Shannon Matzinger, Kevin Berg, Kirsten Weisbeck, Molly Butler, Nicholas J Pysnack, Hai Nguyen-Tran, Emily Spence Davizon, Laura Bankers, Sarah A. Jung, Meghan C Birkholz, Allison Wheeler, and Samuel R. Dominguez. Multimodal surveillance model for enterovirus d68 respiratory disease and acute flaccid myelitis among children in colorado, usa, 2022. Emerging Infectious Diseases, 30:423-431, Mar 2024. URL: https://doi.org/10.3201/eid3003.231223, doi:10.3201/eid3003.231223. This article has 22 citations and is from a domain leading peer-reviewed journal.

  4. (rodesch2024afirstcase pages 1-3): Marine Rodesch, Claudine Sculier, Valentina Lolli, Gauthier Remiche, Iris Delpire, Christophe Fricx, Françoise Vermeulen, and Florence Christiaens. A first case of acute flaccid myelitis related to enterovirus d68 in belgium: case report. Case Reports in Neurology, 16:41-47, Jan 2024. URL: https://doi.org/10.1159/000535316, doi:10.1159/000535316. This article has 4 citations and is from a peer-reviewed journal.

  5. (doi2024midtermoutcomesof pages 1-2): Kazuteru Doi, Yasunori Hattori, Sotetsu Sakamoto, Dawn Sinn Yii Chia, Vijayendrasingh Gour, and Jun Sasaki. Midterm outcomes of surgical reconstruction and spontaneous recovery of upper-extremity paralysis following acute flaccid myelitis. JBJS Open Access, Apr 2024. URL: https://doi.org/10.2106/jbjs.oa.23.00143, doi:10.2106/jbjs.oa.23.00143. This article has 1 citations.

  6. (aguglia2023contemporaryenterovirusd68isolates pages 1-2): Gabrielle Aguglia, Carolyn B. Coyne, Terence S. Dermody, John V. Williams, and Megan Culler Freeman. Contemporary enterovirus-d68 isolates infect human spinal cord organoids. mBio, Aug 2023. URL: https://doi.org/10.1128/mbio.01058-23, doi:10.1128/mbio.01058-23. This article has 22 citations and is from a domain leading peer-reviewed journal.

  7. (rodesch2024afirstcase pages 3-5): Marine Rodesch, Claudine Sculier, Valentina Lolli, Gauthier Remiche, Iris Delpire, Christophe Fricx, Françoise Vermeulen, and Florence Christiaens. A first case of acute flaccid myelitis related to enterovirus d68 in belgium: case report. Case Reports in Neurology, 16:41-47, Jan 2024. URL: https://doi.org/10.1159/000535316, doi:10.1159/000535316. This article has 4 citations and is from a peer-reviewed journal.

  8. (neighbors2024transcutaneousspinalcord pages 5-8): Elizabeth Neighbors, Lia Brunn, Agostina Casamento-Moran, and Rebecca Martin. Transcutaneous spinal cord stimulation enables recovery of walking in children with acute flaccid myelitis. Children, 11:1116, Sep 2024. URL: https://doi.org/10.3390/children11091116, doi:10.3390/children11091116. This article has 2 citations.

  9. (murphy2021acuteflaccidmyelitis pages 1-2): Olwen C Murphy, Kevin Messacar, Leslie Benson, Riley Bove, Jessica L Carpenter, Thomas Crawford, Janet Dean, Roberta DeBiasi, Jay Desai, Matthew J Elrick, Raquel Farias-Moeller, Grace Y Gombolay, Benjamin Greenberg, Matthew Harmelink, Sue Hong, Sarah E Hopkins, Joyce Oleszek, Catherine Otten, Cristina L Sadowsky, Teri L Schreiner, Kiran T Thakur, Keith Van Haren, Carolina M Carballo, Pin Fee Chong, Amary Fall, Vykuntaraju K Gowda, Jelte Helfferich, Ryutaro Kira, Ming Lim, Eduardo L Lopez, Elizabeth M Wells, E Ann Yeh, Carlos A Pardo, Andrea Salazar-Camelo, Divakar Mithal, Molly Wilson-Murphy, Andrea Bauer, Colyn Watkins, Mark Abzug, Samuel Dominguez, Craig Press, Michele Yang, Nusrat Ahsan, Leigh Ramos-Platt, Emmanuelle Tiongson, Mitchel Seruya, Ann Tilton, Elana Katz, Matthew Kirschen, Apurva Shah, Erlinda Ulloa, Sabrina Yum, Lileth Mondok, Megan Blaufuss, Amy Rosenfeld, Wendy Vargas, Jason Zucker, Anusha Yeshokumar, Allison Navis, Kristen Chao, Kaitlin Hagen, Michelle Melicosta, Courtney Porter, Margaret Tunney, Richard Scheuermann, Priya Duggal, Andrew Pekosz, Amy Bayliss, Meghan Moore, Allan Belzberg, Melania Bembea, Caitlin O'Brien, Rebecca Riggs, Jessica Nance, Aaron Milstone, Jessica Rice, Maria A. Garcia-Dominguez, Eoin Flanagan, Jan-Mendelt Tillema, Glendaliz Bosques, Sonal Bhatia, Eliza Gordon-Lipkin, Dawn Deike, Gadi Revivo, Dan Zlotolow, Gabrielle deFiebre, Peggy Lazerow, Timothy Lotze, Ari Bitnun, Kristen Davidge, Jiri Vajsar, Amy Moore, Chamindra Konersman, Kendall Nash, Jonathan Strober, Nalin Gupta, Charles Chiu, Michael Sweeney, William Jackson, Dennis Simon, Kavita Thakkar, Jonathan Cheng, John Luce, Suman Das, Matthew Vogt, NgocHanh Vu, Jacqueline Gofshteyn, Naila Makhani, and Payal Patel. Acute flaccid myelitis: cause, diagnosis, and management. The Lancet, 397:334-346, Jan 2021. URL: https://doi.org/10.1016/s0140-6736(20)32723-9, doi:10.1016/s0140-6736(20)32723-9. This article has 195 citations and is from a highest quality peer-reviewed journal.

  10. (whitehouse2024surveillanceforacute pages 5-6): ER Whitehouse. Surveillance for acute flaccid myelitis―united states, 2018–2022. Unknown journal, 2024.

  11. (whitehouse2024surveillanceforacute pages 6-7): ER Whitehouse. Surveillance for acute flaccid myelitis―united states, 2018–2022. Unknown journal, 2024.

  12. (whitehouse2024surveillanceforacute pages 4-5): ER Whitehouse. Surveillance for acute flaccid myelitis―united states, 2018–2022. Unknown journal, 2024.

  13. (vawterlee2021acuteflaccidmyelitis pages 2-3): Marissa Vawter-Lee, Katrina Peariso, Mary Frey, Priya Bolikal, Joshua K. Schaffzin, Ann Schwentker, William T. O’Brien, Ronine Zamor, and Benjamin T. Kerrey. Acute flaccid myelitis: a multidisciplinary protocol to optimize diagnosis and evaluation. Journal of Child Neurology, 36:421-431, Dec 2021. URL: https://doi.org/10.1177/0883073820975230, doi:10.1177/0883073820975230. This article has 10 citations and is from a peer-reviewed journal.

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