Acute flaccid myelitis (AFM)

Description

Acute flaccid myelitis (AFM) is a rare but serious disease that affects the spinal cord. It can cause a sudden weakness in the arms or legs, loss of muscle tone and loss of reflexes. The condition mainly affects young children.

Most children have a mild respiratory illness or fever caused by a viral infection of one to four weeks before developing symptoms of acute flaccid myelitis.

If you or your child has symptoms of acute flaccid myelitis, seek medical attention immediately. The symptoms can progress rapidly. Hospitalization is needed, and sometimes a fan is necessary for the breathing support.

From the experts began to follow acute flaccid myelitis following initial clusters in 2014, the outbreaks in the united States have occurred in the years 2016 and 2018. Outbreaks tend to occur between the months of August and November.

Symptoms

The most common signs and symptoms of acute flaccid myelitis include:

  • Sudden arm or leg weakness
  • Sudden loss of muscle tone
  • Sudden loss of reflexes

Other possible signs and symptoms include:

  • Difficulty moving the eyes or drooping eyelids
  • Facial drooping or weakness
  • Difficulty swallowing, or difficulty speaking
  • Pain in the arms, legs, neck, or back

Unlikely that the symptoms could include:

  • Numbness or tingly feeling
  • Inability to urinate.

Severe symptoms involving respiratory failure, due to the muscles involved in breathing weaken. Also it is possible to experience life in danger, the body temperature of the changes and the instability of blood pressure.

When to see a doctor

If you or your child has any of the signs or symptoms listed above, seek medical attention as soon as possible.

Causes

Acute flaccid myelitis can be caused by an infection with a type of virus called an enterovirus. Respiratory diseases and fever of the enteroviruses are common — especially in children. The majority of people recover. It is not clear why some people with an infection by enterovirus develop acute flaccid myelitis.

In the united States many of the viruses, including enteroviruses circulate between August and November. This is when acute flaccid myelitis outbreaks tend to occur.

The symptoms of acute flaccid myelitis can look similar to those of the viral disease of polio. But none of the acute flaccid myelitis cases in the united States have been caused by the poliovirus.

Risk factors

Acute flaccid myelitis affects mainly young children.

Complications

Muscle weakness caused by acute flaccid myelitis may continue for months to years.

Prevention

There is No specific way to prevent acute flaccid myelitis. However, the prevention of a viral infection can help reduce the risk of developing acute flaccid myelitis.

Take these steps to help protect you or your child from getting or spreading a viral infection:

  • Wash your hands often with soap and water.
  • Avoid touching the face with unwashed hands.
  • Avoid close contact with people who are sick.
  • Clean and disinfect frequently touched surfaces.
  • Cover coughs and sneezes with a tissue or upper sleeve of the shirt.
  • Keep sick children at home.

Acute flaccid myelitis (AFM)

Diagnosis

To diagnose acute flaccid myelitis, the doctor begins with a complete medical history and a physical examination. The doctor might recommend:

  • The examination of the nervous system. The doctor examines the places in the body where you or your child have a weakness, lack of muscle tone and decreased reflexes.
  • Magnetic resonance imaging (MRI). This imaging test allows the doctor to look at the brain and the spinal cord.
  • The laboratory tests. The doctor may take samples of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid), respiratory fluid, blood, and stool for laboratory testing.
  • A nerve check. This test can verify how fast an electrical impulse moves through the nerves and the response of the muscles to the messages from the nerves.

Acute flaccid myelitis can be difficult to diagnose because it shares many of the same symptoms of other neurological diseases, such as Guillain-Barré syndrome. These tests can help to distinguish acute flaccid myelitis of other conditions.

Treatment

Currently, there is no specific treatment for acute flaccid myelitis. The treatment is aimed at controlling symptoms.

A doctor who specializes in the treatment of brain and spinal cord diseases (neurologist) may recommend physical therapy or occupational therapy to help with arm or leg weakness. If physical therapy is started during the initial phase of the disease, it could improve the long-term recovery.

The doctor may also recommend treatment with immunoglobulin that contains healthy antibodies from healthy donors, drugs that reduce inflammation in the body (corticosteroids) or antiviral drugs. Or the doctor may recommend a treatment that removes and replaces the plasma of the blood (plasma exchange). However, it is not clear whether these treatments have no benefit.

Sometimes, the nerve and the muscle transfer surgery is performed to improve the function of the limb.

Preparing for your appointment

If you have symptoms of acute flaccid myelitis, seek medical attention immediately.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of the following:

  • The signs and symptoms, including any that seem unrelated to the reason for the appointment
  • Medications, including vitamins, herbal and over-the-counter medicines that you or your child are taking, and your dose
  • Key personal information , including recent illnesses, trips and activities
  • Questions to ask the doctor

For acute flaccid myelitis, some basic questions to ask the doctor include:

  • Will additional testing be required?
  • What are the treatment options?
  • What are the benefits and risks of each treatment?
  • There is a treatment that you feel is better?
  • In the event that other specialists to be seen? What will that cost, and will my insurance cover it?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions that occur to you.

What to expect from your doctor

The doctor will ask you or your child for several questions. Be prepared to answer to allow time later to cover other points you want to address. The doctor may ask, for example:

  • When you or your child begin to experience the symptoms?
  • The symptoms are continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you or your child has a viral infection in the last month?
Symptoms and treatment of Acute flaccid myelitis (AFM)