Recent Spike in Cases of Acute Flaccid Myelitis

Reports have been circulating across the United States concerning the recent spike in cases of Acute Flaccid Myelitis (AFM), a subtype of Transverse Myelitis. AFM is inflammation of the spinal cord, and it predominantly affects children. From August 2014 through August 2018, the Centers for Disease Control and Prevention (CDC) has received information on a total of 362 cases of AFM across the U.S.1 The exact cause of AFM has not yet been determined, but it usually follows a respiratory infection and is believed to be caused by a common virus. However, most children who are infected by the virus do not contract AFM.

The most common symptom of AFM is weakness in the limbs and can result in partial or full paralysis in some cases. AFM is diagnosed based upon clinical exam, MRI findings, lumbar puncture, and may also include a nerve conduction study (EMG) to determine if there is injury to the lower motor neuron. Testing may also include blood draws, respiratory tract samples, or collection of other bodily fluids to determine if a viral or infectious component is present. A diagnosis of AFM differs from classically described Transverse Myelitis in that abnormalities on an MRI are predominantly found in the gray matter of the spinal cord in cases of AFM.

To date, there have not been any conclusive studies that prove a viable treatment for AFM; however, treatments available for Transverse Myelitis have been used. These treatments include high dose IV steroids, IVIG, and plasma exchange (PLEX). The CDC does not recommend the use of steroids, IVIG, or plasma exchange in AFM because of a lack of controlled data, but individuals with AFM or caregivers of children with AFM should discuss treatment recommendations with their physician. Multiple centers have used these therapies with variable results. Physical therapy is believed to be critical for recovery in AFM.

If you or someone you know has a child experiencing symptoms consistent with AFM, it is important to seek emergency care immediately. The TMA will be hosting a special podcast on AFM next week with Dr. Benjamin Greenberg of UT Southwestern Medical Center. We will announce the podcast once all details are finalized. Information and support for those affected by AFM can be found using the following resources:

Membership Form: https://myelitis.org/join/

Information Sheet on AFM: https://tma.ong/2y9Ie5v

AFM Resources: https://tma.ong/AFM-resources

Management of AFM: https://www.youtube.com/watch?v=mpe-TkQhrD4&feature=youtu.be&list=PLXi60bECkjnXxzgkf2bk3J12iwVU1Q4ML

Q&A and Podcast: https://myelitis.org/acute-flaccid-myelitis-understanding-recent-outbreak/

2017 Collaborative Meeting on AFM: https://myelitis.org/collaborative-meeting-acute-flaccid-myelitis/

Parents of Children with AFM Share Stories: https://myelitis.org/resources/power-sharing-stories/2/

AFM – What Is It?: https://archive.myelitis.org/resources/Newsletter_Articles/2015_04_15_afm.pdf

[1] AFM Investigation. (2018, October 5). Retrieved October 11, 2018, from https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html

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