This protocol addresses hand, foot and mouth disease (HFMD) or herpangina presenting with central nervous system (CNS) complications — specifically brainstem encephalitis or encephalomyelitis, including cases with acute flaccid paralysis, myoclonic jerks, ataxia, tremors, or limb weakness.
CNS involvement in HFMD can manifest as aseptic meningitis, brainstem encephalitis, or encephalomyelitis, including acute flaccid paralysis. Patients presenting with brainstem encephalitis or encephalomyelitis carry a higher risk of progression to autonomic nervous system dysregulation, making prompt recognition and management critical.
Management combines supportive measures with a specific intravenous immunological therapy, the use of which is guided by the precise neurological presentation. Separate pharmacological considerations apply when seizures or prominent movement-related symptoms are present. The complete protocol — including indications, sequencing, and decision criteria — is available via the link below.
This can manifest as aseptic meningitis, brainstem encephalitis and encephalomyelitis (including acute flaccid paralysis).
On the other hand, patients with brainstem encephalitis or encephalomyelitis are at a higher risk of progression to ANS dysregulation.
Intravenous immunoglobulin (IVIG) * (Recommended in patients with encephalitis plus acute flaccid paralysis; may be considered in patients with brainstem encephalitis)
Seizures are uncommon in children with HFMD. If they occur, routine anti-convulsants may be considered.
Frequent myoclonic jerks, particularly if distressing to the child and parent, may be managed with sedation (e.g. midazolam) and/or anticonvulsants (e.g. phenytoin).
Paracetamol
Oxygen
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