Epidemiology of acute flaccid myelitis in children in the Netherlands, 2014 to 2019.

BackgroundAcute flaccid myelitis (AFM) is a polio-like condition affecting mainly children and involving the central nervous system (CNS). AFM has been associated with different non-polio-enteroviruses (EVs), in particular EV-D68 and EV-A71. Reliable incidence rates in European countries are not available.AimTo report AFM incidence in children in the Netherlands and its occurrence relative to EV-D68 and EV-A71 detections.MethodsIn 10 Dutch hospitals, we reviewed electronic health records of patients diagnosed with a clinical syndrome including limb weakness and/or CNS infection and who were < 18 years old when symptoms started. After excluding those with a clear alternative diagnosis to AFM, those without weakness, and removing duplicate records, only patients diagnosed in January 2014-December 2019 were retained and further classified according to current diagnostic criteria. Incidence rates were based on definite and probable AFM cases. Cases' occurrences during the study period were co-examined with laboratory-surveillance detections of EV-D68 and EV-A71.ResultsAmong 143 patients included, eight were classified as definite and three as probable AFM. AFM mean incidence rate was 0.06/100,000 children/year (95% CI: -0.03 to 0.14). All patient samples were negative for EV-A71. Of respiratory samples in seven patients, five were EV-D68 positive. AFM cases clustered in periods with increased EV-D68 and EV-A71 detections.ConclusionsAFM is rare in children in the Netherlands. The temporal coincidence of EV-D68 circulation and AFM and the detection of this virus in several cases' samples support its association with AFM. Increased AFM awareness among clinicians, adequate diagnostics and case registration matter to monitor the incidence.

Pediatric acute flaccid myelitis: Evaluation of diagnostic criteria and differentiation from other causes of acute flaccid paralysis.

BACKGROUND: Acute flaccid paralysis (AFP) is characterized by rapidly progressive limb weakness with low muscle tone. It has a broad differential diagnosis, which includes acute flaccid myelitis (AFM), a rare polio-like condition that mainly affects young children. Differentiation between AFM and other causes of AFP may be difficult, particularly at onset of disease. Here, we evaluate the diagnostic criteria for AFM and compare AFM to other causes of acute weakness in children, aiming to identify differentiating clinical and diagnostic features. METHODS: The diagnostic criteria for AFM were applied to a cohort of children with acute onset of limb weakness. An initial classification based on positive diagnostic criteria was compared to the final classification, based on application of features suggestive for an alternative diagnosis and discussion with expert neurologists. Cases classified as definite, probable, or possible AFM or uncertain, were compared to cases with an alternative diagnosis. RESULTS: Of 141 patients, seven out of nine patients initially classified as definite AFM, retained this label after further classification. For probable AFM, this was 3/11, for possible AFM 3/14 and for uncertain 11/43. Patients initially classified as probable or possible AFM were most commonly diagnosed with transverse myelitis (16/25). If the initial classification was uncertain, Guillain-Barré syndrome was the most common diagnosis (31/43). Clinical and diagnostic features not included in the diagnostic criteria, were often used for the final classification. CONCLUSION: The current diagnostic criteria for AFM usually perform well, but additional features are sometimes required to distinguish AFM from other conditions.

Registration of attentional function as a predictor of incident delirium (the RAPID study).

INTRODUCTION: Older adults undergoing elective surgery have a high risk of developing postoperative delirium (POD). Validated models predicting POD are scarce. This study investigated whether preoperative impairment of attentional function predicts POD in older adults without previously diagnosed cognitive impairment. METHODS: In this prospective cohort study we recruited patients aged ≥70 years preceding major elective surgery. Preoperatively a visual vigilance test was administered to determine intra-individual reaction-time variability. Postoperatively, presence of delirium was screened daily. RESULTS: We recruited 152 patients, 25 (16.4%) developed POD. Intra-individual reaction-time variability was not significantly different between patients with or without POD (0.18 ± 0.08 ms vs 0.22 ± 0.11 ms; P = 0.087). Receiver operating characteristic analyses indicated a poor accuracy for POD (area under the curve 0.609 ± 0.63). Except for surgery duration, no clinically significant between-group differences were found for secondary outcome parameters. DISCUSSION: Preoperative intra-individual reaction time variability does not predict the incidence of POD in older patients undergoing major elective surgery.

The age gap between patients in clinical studies and in the general population: a pitfall for dementia research.

The growing global disease burden attributable to dementia has strongly stimulated research activities. However, patients with dementia that are included in clinical research are systematically younger than patients from the general population. This large age gap perhaps indicates a lack of methodological rigour, but, more importantly, has the potential to affect the interpretation of research finding-eg, those relating to neuropathology, apolipoprotein E polymorphisms, the effects of cholinesterase inhibitors, and many other issues relevant to patients with dementia. Research on dementia has a lot to gain from the study of patients that more appropriately reflect the population at risk.