Since 2014, pediatricians and neurologists across the United States have seen an increase in cases of acute flaccid myelitis (AFM), an extremely rare but serious condition that attacks the nervous system, leading to weakness and paralysis. While it can be found in people of all ages, AFM affects more children than adults. Though many parents haven’t previously heard of this condition, AFM isn’t new, but the recent uptick in diagnosed cases is. Since the start of 2018, U.S. doctors have confirmed 62 cases of AFM from 22 states.
What is acute flaccid myelitis?
AFM is a complication of a viral infection. Researchers at the Centers for Disease Control and Prevention are working to determine the exact pathogen (germ) behind the virus that causes AFM and to better understand how it spreads from one person to another.
Most of the recent cases are a rare complication of a particular type of enterovirus infection. Enteroviruses are extremely common and usually cause mild respiratory or gastrointestinal infections that resolve on their own. These viruses are transmitted through fecal-oral contact, which means good sanitation and frequent hand washing are most helpful in limiting the spread of AFM and other related diseases.
“While this news can be alarming, we want parents and caretakers to recognize that this condition is still very rare,” says Dr. Paige Kalika, a pediatric neurologist with the University of Miami Health System. Fewer than one in 1 million people in the U.S. are predicted to show symptoms of AFM this year. “Our goal is to help educate the public so people can be aware of the symptoms and seek medical treatment immediately if your child is showing signs of acute flaccid myelitis.”
What does acute flaccid myelitis look like?
AFM causes weakness (flaccidity, floppiness) that can affect one or more limbs. Other symptoms may include weakness of the face and eyelids, difficulty moving the eyes, impaired swallowing and impaired speaking. Some children complain of muscle or nerve pain. Rarely, blood pressure and respiratory function may be affected. In very rare cases, the virus that triggered AFM may also initiate other neurologic issues that can lead to death.
How to respond if your child exhibits symptoms of AFM
“If your child complains of mild, unexplained limb weakness, please visit your pediatrician to see if your child needs an expedited appointment with a neurologist,” Dr. Kalika recommends. “However, if your child develops rapid onset of face, body or limb weakness, please go to the emergency department of a children’s hospital for urgent evaluation. There, a team of neurologists, pediatricians, pediatric intensive care doctors, pediatric physiatrists and other specialists can rapidly evaluate your child to see which tests and treatments are most appropriate.”
Testing that can help doctors determine an appropriate diagnosis and prognosis of AFM include MRIs, blood and cerebrospinal fluid tests and nerve conduction tests.
Dr. Kalika warns, “Diagnosing the ultimate cause of AFM can be complicated. It can take days or weeks for some of the lab tests to come back, and the virus that triggers the disease cannot always be identified. However, even without identifying a specific virus, doctors are able to begin treatment.”
Treating acute flaccid myelitis
While there are no medications nor vaccines specific to AFM, the condition may respond to different treatments that help alleviate symptoms.
“Good supportive care is crucial,” says Dr. Kalika. “Treatment of acute flaccid myelitis focuses on whichever symptoms are most bothersome. After the patient has stabilized, physical and occupational therapy are of utmost importance in helping them regain their strength and mobility.
“While AFM is a serious condition, and not every person may make a full recovery, it is important to remember that we are working hard to learn more about this condition. Affected children can continue to improve every day.”
Dana Kantrowitz is a contributing writer for UMiami Health News.