Acute Flaccid Myelitis: Pediatric Cases Rising in the u.S.

Every so often, an illness outbreak peaks in the United States, raising red flags with health officials. Inevitably, the ensuing coverage of the illness ignites fear and panic in the hearts of parents everywhere. Acute flaccid myelitis (AFM) is a rare condition affecting the grey matter of the spinal cord that causes a polio-like illness. AFM has spiked in children over the past few years, causing concern in both doctors and parents.

The Centers for Disease Control and Prevention (CDC) reports that acute flaccid myelitis has been confirmed in 22 states so far in 2018. This represents a significant increase from 2017. While AFM is not new, the CDC began noticing an increase in the number of cases as early as 2014. Even more concerning is the fact that more than 90 percent of the cases involve children younger than 18 years of age.

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Acute flaccid myelitis is a condition that affects the grey matter of the spinal cord, causing the muscles to become very weak. A person with AFM also loses normal reflexes in the arms and legs. Other symptoms may include:

• Pain in the arms or legs
• Difficulty swallowing
• Slurred speech
• Facial weakness and droop
• Difficulty moving the eyes
• Drooping eyelids

If AFM progresses, it can lead to weak breathing and respiratory failure in severe cases. Patients may need to be placed on a ventilator to support their weak muscles.

If your child develops these symptoms, it is imperative to seek medical help right away in a hospital setting. Your child’s doctor will likely perform a variety of tests, including a lumbar puncture to look at the fluid surrounding the brain and spinal cord, an MRI of the brain and spine, and a nerve conduction test to see how well the nerves are firing.

There is no obvious cause of AFM, although researchers suspect a virus may trigger the illness in many cases. Some viruses that may be associated include enteroviruses, polioviruses, adenoviruses, and West Nile Virus and other similar viruses that cause encephalitis. According to the CDC, other theories include environmental toxins and genetic disorders. Vaccines have not been shown to play a role in causing AFM, as both vaccinated and unvaccinated children have been affected. Often, a final cause is never determined.

AFM has no definitive treatment or cure, so doctors are often left treating the symptoms of the illness without treating the underlying cause. Therapy is an important part of the recovery process, including physical and occupational therapy to improve muscle strength. Some patients are treated with high-dose steroids, while others are given an infusion of IVIG, an IV solution of antibodies derived from blood products. Some patients have received plasmapheresis, a process that filters the blood. Patients are treated on a case-by-case basis as there are no treatment protocols. Some patients recover quickly, while others suffer from prolonged paralysis.

Although researchers have not identified a cause of AFM, the CDC recommends the following precautions: be sure to stay up to date on vaccines, protect your child from mosquitoes, and practice good hand washing techniques.

Sources:

• American Academy of Pediatrics
• Acute Flaccid Myelitis In Children.
  Centers for Disease Control & Prevention
• Acute Flaccid Myelitis in U.S
• Children.
  Centers for Disease Control & Prevention
• AFM Investigation.

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