EMG/NCV Changes in 2 Pediatric Patients with Acute Onset Flaccid Paralysis (P6.261)

Background: Enterovirus D68 has been associated with pediatric flaccid paralysis. Methods/Design: Description of the EMG/NCV findings in two cases of sudden onset paralysis in 2 children; one confirmed Enterovirus D68 positive. Case #1: A 6 y.o. typically developing girl presented after one week of URI symptoms and fever with trouble ambulating and meningismus. On examination, she had proximal predominant bilateral upper extremity flaccid weakness, right more than left, with preserved lower extremity strength. Her CSF had a lymphocyte predominant pleocytosis and elevated protein. Spine MRI revealed contiguous central gray matter predominant T2 signal hyperintensity throughout the length of the cord with a cervical cord expansion and a single small focus of enhancement at level C4-5. EMG/NCV demonstrated intact CMAPs and SNAPs with no F-waves obtainable. Needle EMG demonstrated no MUAPs generated in affected muscle. Stool was positive for enterovirus 68. Case #2 A 9 y.o. typically developing girl was transferred for inpatient rehabilitation unimproved following IV methylprednisolone. Initial symptoms were progressive bilateral lower extremity weakness preceded by two weeks of fever, headache, URI and GI symptoms. MRI spine with T2 hyperintensity of the cord with expansion from T8-9 extending to the conus involving the anterior horn cells and nerve root clumping. EMG/NCV findings were consistent with AIDP. Her CSF had elevated WBCs (lymphocyte predominant) and protein. Repeat EMG/NCV at CHLA demonstrated absent F-waves. Needle electrode studies demonstrated no MUAPs in affected muscle. Discussion: These two cases demonstrate a constellation of central/anterior cord involvement, CSF lymphocyte predominant pleocytosis and elevated protein, and similar EMG/NCV findings of absent F-waves and MUAPs in affected muscles. Conclusion: EMG/NCV may be helpful as part of the clinical investigations to decipher between the causes of flaccid paralysis in children. Further studies are needed to confirm this EMG/NCV pattern is consistent with these cases. Disclosure: Dr. Droker has nothing to disclose. Dr. Tiongson has nothing to disclose. Dr. Luc has nothing to disclose. Dr. Sadrieh has nothing to disclose. Dr. Rosser has nothing to disclose. Dr. Desai has nothing to disclose. Dr. Ramos-Platt has nothing to disclose.