What Causes Acute Flaccid Myelitis (AFM)?

Acute flaccid myelitis (AFM) initially starts with a fever. After one to two weeks, AFM may progress to muscle weakness, which may progress rapidly within hours to a few days

The most common symptoms of AFM include

• Sudden onset of arm or leg weakness
• Loss of muscle tone
• Loss of reflexes

Other symptoms of AFM that are not so common may include

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

The most severe symptoms of AFM include

• Respiratory failure (when the breathing muscles become weak, requiring the assistance of ventilators for breathing support)
• Serious neurologic complications such as changes in body temperature and blood pressure fluctuations could be life-threatening

Seek immediate medical attention as soon as you see symptoms of weakness in the children as the symptoms tend to progress rapidly, leading to serious complications.

To date, no specific treatment can cure acute flaccid myelitis (AFM). Early treatment may include supportive care and rehabilitation therapies. Supportive care may include

• Hospital admissions to prevent the rapid progression of symptoms
• Intravenous immunoglobulins are given over four to five days if AFM is restricted to grey matter (immunoglobulins lower inflammation in the body)
• A combination of steroids and plasma exchange if the AFM has spread to upper and lower nerve cells
• Antiviral drugs to treat the viral infection

However, there is insufficient evidence about the effectiveness of this supportive care in the management of AFM.

Rehabilitation therapy may include

• Physical or occupational therapy to help recover arm or leg weakness
• Electrical stimulation

Surgery is the last resort if the muscle movement is not restored with supportive care and rehabilitation therapy. Nerve transfer is a surgical procedure that involves connecting a working nerve to a dysfunctional muscle. Over time, the nerve grows into a muscle, then becomes a functional muscle. It helps children get better movement and strength in their limbs.

It is still unknown if acute flaccid myelitis (AFM) can be reversed completely. Most studies have reported that children with AFM may regain some strength over time. But many children may still face muscle weakness in the affected limb for months or years. Recovery is still possible with rehabilitation therapy but may be gradual and requires patience.