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Everything you need to know about acute flaccid myelitis

This rare but very serious condition can cause paralysis in children

Dr. Crutchfield, I saw on the news that many Minnesota children are developing polio-like symptoms. What is this about?

The condition is called acute flaccid myelitis (AFM). It is a rare,
but very serious condition that affects a person’s nervous system via
the spinal cord. The results are a weakening of one or more of the arms
or legs or other muscles of the body. The weakening of the legs can
cause extreme difficulty walking and even paralysis. As a result, the
condition is very similar, clinically, to polio.

Some patients make a rapid recovery and others may have a lengthy,
perhaps even permanent paralysis. The prognosis can vary depending on
the patient. If a person does have AFM, it is essential to use all
treatment and rehabilitation options available.

We currently are uncertain of what causes AFM. There may be one
singular cause, or the condition may be a result of many causes that can
produce the same effects. Scientists postulate that it could be a
yet-to-be-identified virus or even environmental toxin. I would also
submit for consideration infectious proteins called “prions” that can
cause disease. Additionally, doctors are not sure of any factors that
would increase one’s risk of developing AFM.

What we do know

  • The condition is very rare, affecting less than one in a million persons in the United States.
  • There have been six documented cases of AFM in Minnesota, with over 20 suspected cases.
  • From August 2014 through September 2018, there have been about 390
    reported cases of AFM in the United States. (Reporting is voluntary, so
    this number is probably lower than the actual number of cases that have
    actually occurred.)
  • Most cases are of children. The average age is four, and 90 percent of cases occur in those younger than 18.
  • In no cases have doctors discovered a causative agent, including the polio virus.

Symptoms

  • Sudden weakness in the arms or legs
  • Facial droop
  • Facial weakness
  • Slurred speech
  • Drooping eyelids
  • Difficulty moving the eyes
  • Difficulty swallowing
  • Difficulty breathing. This is the most severe complication of AFM
    because a weakening of the muscle that controls breathing is a medical
    emergency that, without immediate support, can lead to death.

What the Centers for Disease Control (CDC) is doing

The CDC is actively investigating all reported cases of AFM and
working closely with doctors and other healthcare providers and health
departments to increase awareness of AFM.

CDC activities include:

  • Encouraging healthcare providers to be watchful and report suspected cases of AFM
  • Actively looking for risk factors for developing AFM
  • Testing specimens, including stool, blood, and cerebrospinal fluid, from alleged AFM cases
  • Working with researchers across the country and world to determine the cause of AFM
  • Disseminating all new information on AFM to doctors, healthcare providers, and health departments as it becomes available

What you can do

Because the condition mimics the result of a viral infection, it is essential to:

  • Practice good hand-washing techniques
  • Use appropriate mosquito repellants and protection
  • Ensure all vaccinations are up to date

If your child develops weakness of any limb, especially if they have
cold-like symptoms or other viral symptoms, take them to the doctor
immediately. The prognosis now depends on getting prompt medical care as
soon as possible.

Eventually, we will understand the cause of AFM. Until then, these
action steps are our best hope for prevention and a good recovery.

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