Acute Flaccid Myelitis: A Clinical Overview for 2019 Yasaman Fatemi, MD, and Rana Chakraborty, MD, MSc, DPhil (Oxon) CME Activity Target Audience: The target audience for Mayo Clinic Proceedings is primar- ily internal medicine physicians and other clinicians who wish to advance their current knowledge of clinical medicine and who wish to stay abreast of advances in medical research. Statement of Need: General internists and primary care physicians must maintain an extensive knowledge base on a wide variety of topics covering all body systems as well as common and uncommon disorders. Mayo Clinic Proceedings aims to leverage the expertise of its authors to help physicians understand best practices in diagnosis and management of conditions encountered in the clinical setting. Accreditation Statement: In support of improving patient care, Mayo Clinic College of Medicine and Science is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Educa- tion (ACPE), and the American Nurses Cre- dentialing Center (ANCC) to provide continuing education for the healthcare team. Credit Statements: AMA: Mayo Clinic College of Medicine and Science des- ignates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). TM Physicians should claim only the credit commensu- rate with the extent of their participation in the activity. MOC Credit Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit partici- pant completion information to ACCME for the purpose of granting ABIM MOC credit. Learning Objectives: On completion of this article, you should be able to (1) summarize the case definition of acute flaccid myelitis (AFM) and describe the clinical manifestations of AFM, (2) recall the recent outbreaks of AFM in the United States and the possible epidemiological associations with enteroviral infections, and (3) recognize the importance of reporting suspected AFM cases to the Centers for Disease Control and Prevention and the key role supportive management currently has in improving me- dium- and long-term outcomes. Disclosures: As a provider accredited by ACCME, Mayo Clinic College of Medicine and Science (Mayo School of Continuous Professional Develop- ment) must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course Director(s), Planning Committee mem- bers, Faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial rela- tionships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty also will disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be published in course materials so that those partic- ipants in the activity may formulate their own judgments regarding the pre- sentation. In their editorial and administrative roles, Karl A. Nath, MBChB, Terry L. Jopke, Kimberly D. Sankey, and Jenna M. Pederson, have control of the content of this program but have no relevant financial relationship(s) with industry. The authors report no competing interests. Method of Participation: In order to claim credit, participants must com- plete the following: 1. Read the activity. 2. Complete the online CME Test and Evaluation. Participants must achieve a score of 80% on the CME Test. One retake is allowed. Visit www.mayoclinicproceedings.org, select CME, and then select CME arti- cles to locate this article online to access the online process. On successful completion of the online test and evaluation, you can instantly download and print your certificate of credit. Estimated Time: The estimated time to complete each article is approxi- mately 1 hour. Hardware/Software: PC or MAC with Internet access. Date of Release: 5/1/2019 Expiration Date: 4/30/2021 (Credit can no longer be offered after it has passed the expiration date.) Privacy Policy: http://www.mayoclinic.org/global/privacy.html Questions? Contact [email protected]. Abstract Acute flaccid myelitis (AFM) is characterized by flaccid paralysis of one or more limbs, often following a viral illness, with magnetic resonance imaging findings consistent with inflammation of the spinal cord gray matter. It is unclear whether all patients with AFM will have full recovery of neurologic function. Since 2014, there have been several clusters of AFM in the United States, with a 3-fold increase in reported AFM cases recorded in 2018 compared with the previous year. Epidemiolog- ical evidence supports a temporal association between respiratory enteroviral illness, particularly with enteroviruses D68 and A71, and clustering of AFM cases. However, causality has yet to be established. Treatment of AFM is primarily supportive. Adjunctive therapies such as intravenous immunoglobulin, corticosteroids, plasmapheresis, and fluoxetine have not been found to improve long-term outcomes. Further research is urgently needed to characterize and optimize management of this emerging, yet poorly understood, condition. ª 2019 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2019;94(5):875-881 From the Division of General Pediatric and Adolescent Medicine (Y.F.) and Division of Pe- diatric Infectious Diseases (R.C.), Department of Pe- diatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN. CONCISE REVIEW FOR CLINICIANS Mayo Clin Proc. n May 2019;94(5):875-881 n https://doi.org/10.1016/j.mayocp.2019.03.011 www.mayoclinicproceedings.org n ª 2019 Mayo Foundation for Medical Education and Research 875
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