What is acute flaccid myelitis?

Cases of acute flaccid myelitis, a polio-like syndrome that can cause paralysis or muscle weakness in children, appear to be on the rise this year.

The Centers for Disease Control and Prevention report 38 cases confirmed so far this year and several states, including Colorado and Minnesota, are investigating an apparent increase in the number of cases.

What is acute flaccid myelitis, AFM?

It looks like polio

The AFM affects the nervous system, especially the gray matter of the spinal cord, says the CDC. Depending on which part of the spine is damaged, different muscles can weaken or paralyze.

This can lead to a range of symptoms, ranging from difficulty lifting an arm to a significant weakening of the muscles that help with breathing. This may require the use of a ventilator to help the patient breathe. "In very rare cases, it is possible that the process in the body that triggers the AFM also triggers other serious neurological complications that can lead to death," says the CDC.

Several viruses can be the cause

Infection with many different viruses can lead to neurological complications. AFM can be one of them. The same is true for transverse myeletis, as well as for Guillain-Barré syndrome.

A virus called EV-D68 was the original suspect, as EV-D68 was circulating during the first large increase in the number of AFD cases in 2014. This year in Colorado, a virus called EV-A71 was circulating in Colorado and was associated to many of the 14 cases there. EV-D68 and EV-A71 are enteroviruses, they belong to the same family of viruses as the polio virus. Poliomyelitis is known to have caused neurological complications, including almost complete paralysis, but also limb weakness. Polio has caused regular epidemics until vaccination has wiped out most countries.

According to the CDC, other viruses, such as adenoviruses, responsible for cold symptoms, and West Nile virus, can also trigger neurological syndromes such as MFA, as well as encephalitis and meningitis as well as more vague symptoms. such as dizziness, convulsions and loss of balance.

But, notes the CDC, many AFM patients have no evidence of specific viral infection. This does not necessarily mean that they have not been infected, but that it is very difficult to diagnose certain viral infections. It is possible that the symptoms are the cause, for example a bacterial infection or other.

Case counts wax and wane

Probably because it is related to viral infections, the number of AFM cases increases and decreases from one exercise to the next. Cases tend to begin to increase in August, just as the school begins, but it is unclear whether school plays a role in spreading the viruses that are at the root of the disease.

The CDC reported 120 cases in 2014, then only 22 in 2015. Then, the number of cases further increased to reach 149 in 2016. According to the CDC, only 33 cases were reported last year. This trend every two years suggests that 2018 could be another year in which more cases are reported.

Effects can be lasting

Some children with AFM recover fully, but others are disabled for years. For example, Carter Roberts of Richmond, Va., Died in September after being paralyzed for two years by what his parents called AFM. Other children have followed years of physical therapy to strengthen other muscles in their body to compensate for the lesions.

There is no specific treatment for AFM, says the CDC. Once the virus has attacked the nervous system, no known medical intervention can reverse the effects. Rehabilitation can help patients recover their function.

This is very rare

About 4 million children are born each year in the United States, but the CDC has only confirmed 362 cases since 2014.

Spotting Symptoms

The CDC urges parents to promptly bring their children to the emergency and recommends doctors to suspect AFM or another neurological disorder if the child has the following symptoms:

• Difficulty moving eyes or droopy eyelids
• Sagging or weakness of the face
• Difficulty swallowing or difficulty speaking
• Sudden weakness of the arm or leg