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Acute Flaccid Myelitis, A Polio-like Illness Affecting Children

by Dr. C.H. Weaver M.D. 10/2018

Recent media reports and federal health officials this week have warned about an increase in the number of children diagnosed with acute flaccid myelitis (AFM). Acute flaccid myelitis is an uncommon polio-like condition affecting mainly children across the US. According to the Center for Disease Control (CDC) 127 people are believed to have contracted AFM, and their average age is 4.

What is Acute Flaccid Myelitis or AFM?

Acute flaccid myelitis is a rare condition that affects a person’s nervous system, specifically the grey matter in the spinal cord, causing weakness in one or more limbs. The CDC estimates that less than one in a million people in the United States will get AFM every year. There are a variety of possible causes of AFM, such as viruses, environmental toxins, and genetic disorders.

What Are the Symptoms of Acute Flaccid Myelitis or AFM?

The hallmark of AFM is the sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Additional symptoms may include;

  • facial droop/weakness
  • difficulty moving the eyes
  • drooping eyelids
  • difficulty with swallowing or slurred speech
  • difficulty urinating
  • respiratory failure
  • numbness and tingling in the extremities

How is Acute Flaccid Myelitis or AFM Diagnosed?

An MRI (magnetic resonance imaging) to look at a patient’s brain and spinal cord combined with lab tests on the cerebrospinal fluid obtained from a lumbar puncture combined with an examination of a patient’s nervous system is necessary to make the diagnosis. AFM is difficult to diagnose because it shares many of the same symptoms as other neurologic diseases.

What is The Cause of AFM?

The exact cause of AFM often remains undetermined but is thought to be related to viruses, environmental toxins, and various genetic disorders. Viruses that can cause AFM or similar neurologic conditions include the polio virus, west Nile virus, Japanese encephalitis virus, Saint Louis encephalitis virus, non-polio enteroviruses and adenoviruses.

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What is The Treatment for Acute Flaccid Myelitis or AFM?

There is no specific treatment for AFM, but a doctor who specializes in treating brain and spinal cord illnesses (neurologist) may recommend certain interventions on a case-by-case basis. For example, neurologists may recommend physical or occupational therapy to help with arm or leg weakness caused by AFM. We do not know the long-term outcomes (prognosis) of people with AFM.

How Can Acute Flaccid Myelitis or AFM Be Prevented?

· Avoid mosquito bites which can transmit many of the suspect viruses

· Make sure you were vaccinated for the polioviruses.

· Good hygiene and hand washing.

What we Know About the Recent Rise in AFM?

  • Between August 2014 through September 2018, there were 386 confirmed cases of AFM across the US.
  • Most of the patients are children under the age of 18, with the average age of 4 years old.
  • All of the AFM cases so far have tested negative for poliovirus.
  • The last major uptick in AFM cases happened in 2014 and coincided with an outbreak of enteroviruses which is a respiratory infection that spreads from person to person by coughing or sneezing, and typically manifests with cold-like symptoms.
  • Parents can protect their kids from serious illnesses like AFM by washing their hands, making sure vaccines are up to date, and using insect repellent to prevent mosquito bites.

For more information on what the CDC is doing, see their AFM Investigation page.