To describe the clinical features and outcomes of different etiologic subgroups of non-traumatic myelopathies that affect children.

Children with a diagnosis of myelopathy and age of onset less than 21 years of age seen at the Johns Hopkins Myelitis and Myelopathy Center (JHMMC) between January 2010 and June 2019 were included. Clinical profile, neurological examination, neuroimaging and cerebrospinal fluid (CSF) features were analyzed. Etiological subgroups included: autoimmune (AM), acute flaccid myelitis (AFM), non-AFM infection-related, vascular myelopathies (VM) and “other” etiologies. Functional disability defined by the modified Rankin score (mRs) was compared between etiologic subgroups at acute and convalescent phase of illness. Factors associated with worse disability were identified with multivariate logistic regression model

One-hunderd and thirty-one subjects were identified (mean age 9.5 years), of whom 50.4% were male. Thirty-four subjects were diagnosed with VM, 29 with AM, 18 with non-AFM infectious-related myelopathies, 40 with AFM and 10 with “other” etiologies. The mRs during the acute phase of illness was higher in the VM group (median 5) in comparison to the other etiology subgroups. All the groups improved from acute to convalescent stage of illness. However, during the convalescent stage, the VM and AFM groups had worse disability outcomes compared to AM, Non- AFM infection related and “other” etiologies. Respiratory failure was associated with worse mRs at convalescent stage (OR 2.41, p value 0.005).

In this large single center study, patients with VM and AFM etiology had worse functionality during both acute and convalescent phases of illness when compared to other etiology subgroups. All etiology groups showed improvement in disability scores from acute to convalescent phase. Factor associated with worse outcome included respiratory failure.