Acute Flaccid Myelitis
Acute Flaccid Myelitis
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DOI：
10.1016/j.pmr.2021.02.004
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发表时间：
2021-06-24
影响因子：
1.7
通讯作者：
Trovato, Melissa K.
中科院分区：
文献类型：
--
作者：
Ide, William;Melicosta, Michelle;Trovato, Melissa K.
AFM是一种不完全了解的迟缓性瘫痪综合征，主要影响儿童，在出现急性感染症状之前，通过累及脊髓灰质的病变来识别。虽然已经使用了几种治疗方法来试图阻止或限制在疾病急性期发生的神经损伤，但目前还没有一种被证明有效，这给大多数受影响的人留下了持久的损害。不同患者的临床表现、瘫痪类型和严重程度以及康复轨迹有很大的异质性，这就需要一种量身定制的、个性化的康复方法。聘请一支熟练的多学科康复团队来应对AFM对患者的活动能力、呼吸状态、自主神经功能、沟通、社交和心理健康的广泛且往往是深远的影响是至关重要的。目前对原子力显微镜的认识在该病的各个方面都存在着显著的差距。文献解释被广泛和不断演变的流行病学病例定义所混淆，该定义旨在优化报告，而不是提供临床诊断精确度。然而，了解已知的流行病学、特征、检查、治疗和潜在的替代诊断对于最好地装备提供者对抗AFM及其长期后遗症是必要的。儿科和成人康复医生在观察AFM的过程、仔细检查干预措施并努力在未来几年发挥最大功能方面具有独特的地位。
AFM is an incompletely understood syndrome of flaccid paralysis, predominately affecting children, preceded by acute infectious symptoms and identified by lesions involving the spinal cord gray matter. Although several treatments have been used in an attempt to halt or limit neurologic damage occurring during the acute phase of the disease, none have presently been proven effective, leaving most affected individuals with lasting impairments. There is substantial heterogeneity in the clinical presentation, pattern, and severity of paralysis, and trajectory of recovery for various patients, necessitating a tailored, individualized approach to rehabilitation. Employment of a skilled multidisciplinary rehabilitation team to address AFM's extensive and often profound impacts on a patient's mobility, respiratory status, autonomic function, communication, social interaction, and mental health is essential. Significant gaps in the current knowledge of AFM persist in every aspect of the disease. Literature interpretation is confounded by a broad and evolving epidemiologic case definition, which has been engineered to optimize reporting rather than provide clinical diagnostic precision. An understanding of known epidemiology, characteristics, workup, therapies, and potential alternative diagnoses is nevertheless necessary to best equip providers combating AFM and its long-term sequelae. Pediatric and adult rehabilitation physicians are uniquely positioned to observe the course of AFM, scrutinize interventions, and strive to maximize function for years to come.