Acute Flaccid Myelitis: What You Need to Know
Recently, a rare condition called acute flaccid myelitis (AFM) has hit the media and the United States has seen a sharp increase in cases over the last year. The Centers for Disease Control and Prevention (CDC) has shown concern over the spike, and although AFM is a rare disease, it is important to know the symptoms and how to protect your child. We asked our medical expert, Jill A. Hoffman, MD, Infectious Diseases at Children’s Hospital Los Angeles, for advice.
What is acute flaccid myelitis?
Hoffman: AFM is a polio-like condition that affects the nervous system and can cause lifelong paralysis. It can result from a variety of causes including viral infections. The most recent cases are associated with an enterovirus called D68.
What are the symptoms that parents should be aware of?
Hoffman: Some kids will have respiratory or gastrointestinal symptoms and then develop sudden weakness or decreased movement of one or more extremity.
What actions should parents take when these symptoms are apparent?
Hoffman: Bring your child to their pediatrician or the nearest emergency department.
Why are we seeing an increase in cases?
Hoffman: Enteroviruses are very common late summer and fall viruses, and different types circulate in different years. Most cause no symptoms or mild upper respiratory infection or gastrointestinal issues and are self-limited, which means they completely resolve without treatment. Last year, we did not have any AFM cases, but this year we have seen about eight. This change would be expected as these serotypes do fluctuate from year to year.
Is CHLA prepared to see patients with AFM?
Hoffman: We are always prepared. We are very good at recognizing these cases, and flaccid paralysis of extremities in a child is rare and notable. So, these symptoms come to our attention very quickly.
What is the treatment and what has been the outcome?
Hoffman: Though we are able to diagnose this syndrome, there is currently no antiviral therapy that has been shown to improve outcome even with ongoing physical therapy. In other words, most patients diagnosed with AFM are left with some neurologic sequealea that is likely permanent.
Mitchel Seruya, MD, director of CHLA’s Brachial Plexus and Peripheral Nerve Center in the Division of Plastic and Maxillofacial Surgery, who is a fellowship-trained pediatric hand and microsurgeon that specializes in peripheral nerve surgery of the face, arms and legs at CHLA, adds, "With that said, depending on the extent of paralysis, patients may be candidates for nerve transfer surgery to improve the strength of select muscles. This a surgery whereby healthy, expendable nerves from muscles of less importance are transferred to paralyzed muscles more critical to function. We may order a nerve conduction and muscle study to better determine the likelihood of spontaneous recovery of the paralyzed muscles and evaluate whether your child has expendable nerves that can be used to bypass the areas of paralysis. I have successfully performed this surgery in other patients with AFM and is actively designing a research protocol across multiple institutions to determine the efficacy of nerve transfer surgery for AFM."
To make a clinical appointment, please call 323-361-5682.
What kind of specialists would a child see if discovered they have AFM?
Hoffman: Usually Neurology and Infectious Diseases
How can parents protect their children?
Hoffman: Teaching how to properly wash hands and cough etiquette. These are both difficult with small children, but parents should model and teach kids as early as possible to do the same.
Should parents be worried?
Hoffman: No, as this is a very rare outcome.
To find out more information and the latest updates on acute flaccid myelitis, visit CDC.gov.