Paralyzed With Fear: Acute Flaccid Myelitis

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By Briana Schreckengost

Acute flaccid myelitis (AFM), colloquially deemed the ‘polio-like illness’, has been in the news recently, with over 190 reports under investigation, 72 of which have been confirmed so far in 2018.1 Pittsburgh alone has seen five confirmed cases of children presenting with this condition and others that are still under investigation.2 As word of this illness spreads, parents may be wondering “What is this condition? Does this mean that polio is back?” Information about AFM and this year’s outbreak is still emerging, but there is a fair amount of data available to help people understand what is happening.

What is AFM?

AFM is a rare condition that affects the spinal cord, leading to symptoms that impact the nervous system.3 Cases are most often seen in children. Parents may see sudden and new instances of extremity weakness along with loss of muscle tone and reflexes that may lead to paralysis.  Additional possible symptoms include weakness of the face, drooping eyelids or trouble moving the eyes, or difficulty with speech or swallowing. In severe cases of AFM, patients may experience other symptoms such as numbness, pain, or tingling, and trouble breathing from weakened muscles.3,4

Confirmation of AFM generally requires an examination of the patient, in addition to supportive evidence from magnetic resonance imaging (MRI).4 Diagnosis of AFM can be difficult in some cases due to its similarity to other neurological illnesses.3


Is AFM new?

Although we have been hearing about AFM a lot recently, the condition has been known for some time. The Centers for Disease Control and Prevention (CDC) provides information on confirmed AFM cases. The condition first started to spike in 2014, with 120 confirmed cases in 34 states from August to December of that year. The second prominent outbreak occurred in 2016, with 139 cases across 39 states. As of October 2018, the CDC has received a confirmed 396 cases from various areas in the United States.  At this time the causes of the outbreaks are still unknown and no link between cases has been identified.1

What causes AFM?

Currently, AFM (like similar neurological conditions) has been associated with common viral infections, such as enteroviruses or adenoviruses. However, it is not known why some individuals with these common viruses develop AFM, while most do not. West Nile virus, most commonly transmitted by mosquitos, has also been associated with AFM. While poliovirus can also be a potential cause of AFM, and AFM symptoms resemble polio, it is important to know that they are not the same illness and no one with AFM in this outbreak has tested positive for poliovirus.3

Is AFM permanent?

At current time, there is no specific treatment for AFM. Each case is unique, and physical and/or occupational therapy may be utilized to help with weakness from the illness. Furthermore, there are no predictive factors for how children will recover from AFM and the long term effects of the condition are still unknown.1 Some patients with AFM have recovered quickly but many have persistent weakness and paralysis. Evidence suggests that early detection of AFM may improve how children recover.5

Is AFM preventable?

Right now, it is not known if or how AFM can be prevented. However, it is encouraged that everyone practice the same common measures they would to prevent other illnesses such as the cold and flu. This includes handwashing, especially before eating, after using the bathroom, after touching animals or playing outside, and when in the vicinity of others who are sick. Keeping home surfaces cleaned and sanitized regularly is another useful practice.6 Since AFM has been associated with mosquito-borne viruses, use of mosquito repellent and other usual protective measures are also advised during warmer seasons. Finally, it is recommended that everyone stay current and up-to-date with all vaccines to keep from getting ill.3,6

Conclusion

As more cases of AFM are confirmed, doctors and researchers gain more knowledge about how to best manage the illness and help patients recover. If you notice symptoms in your child that you think might be AFM, be sure to seek medical advice as soon as possible. For more information, talk to your doctor or pediatrician, or visit https://www.cdc.gov/acute-flaccid-myelitis/about-afm.html.

References

  1. Centers for Disease Control and Prevention. AFM Investigation. https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html. Accessed October 26, 2018.
  2. Allegheny County Health Department. Confirmed and Suspected Cases of Acute Flaccid Myelitis in Allegheny County. http://www.alleghenycounty.us/Health-Department/AFM-Alert.aspx. Accessed November 2, 2018.
  3. Centers for Disease Control and Prevention. Acute Flaccid Myelitis. https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html. Accessed October 26, 2018.
  4. American Academy of Pediatrics. Acute Flaccid Myelitis in Children. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Children-and-Disasters/Pages/Acute-Flaccid-Myelitis-in-Children.aspx. Accessed October 28, 2018.
  5. Cleveland Clinic. Acute Flaccid Myelitis: A Modern-day Polio? https://consultqd.clevelandclinic.org/acute-flaccid-myelitis-a-modern-day-polio/. Accessed November 2, 2018.
  6. Healthy Children. AFM: The Polio-Like Mystery Illness. https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/AFM.aspx. Accessed October 26, 2018.

This article was written by Briana Schreckengost, a student pharmacist at Duquesne University School of Pharmacy, and reviewed by her faculty advisor, Dr. Jordan Covvey.

Briana is currently a fifth year pharmacy student and works as an intern at UPMC Children’s Hospital of Pittsburgh. She is participating in Health Economics and Outcomes Research electives to pursue a Bachelor degree in Pharmaceutical Sciences, in addition to her Doctor of Pharmacy. She also holds a leadership role in the Emerging Leaders Committee of the Juvenile Diabetes Research Foundation. After graduation, Briana would like to pursue a pediatric pharmacy residency and practice in a neonatal intensive care or cardiac intensive care setting.

Dr. Covvey is an Assistant Professor in Pharmacy Administration at the Duquesne University School of Pharmacy. She earned her Doctor of Pharmacy from the University of Kentucky in 2010, and then completed residency training at Virginia Commonwealth University Health System in 2011. She subsequently passed her board certification in pharmacotherapy (BCPS) and was selected as a recipient of a Fulbright grant to complete a Doctor of Philosophy at the University of Strathclyde Institute of Pharmacy and Biomedical Sciences in Scotland. She currently teaches in the public and global health curriculum for pharmacy students at Duquesne, and her research area is in health outcomes and the utilization of healthcare data, such as electronic medical records, for quality improvement in clinical care.