Acute Flaccid Myelitis: Causes, Symptoms and Diagnosis

Written by Medicover Team and Medically Reviewed by Dr Prachi Rahul Pawar , Neurologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Acute Flaccid Myelitis (AFM) is a rare but serious neurological condition that predominantly affects children, leading to sudden muscle weakness and even paralysis. Often likened to polio, AFM has emerged as a significant public health concern due to its severe symptoms and potential long-term impacts.

Acute Flaccid Myelitis is a condition characterized by the inflammation of the spinal cord, resulting in sudden onset of muscle weakness and loss of muscle tone. The disease primarily targets children, with most cases occurring in individuals under 18 years of age. Although AFM is rare, its rapid progression and severe outcomes necessitate immediate medical attention.

What Are the Symptoms of Acute Flaccid Myelitis?

The symptoms of AFM often resemble those of other viral infections, making early diagnosis challenging. However, some hallmark symptoms distinguish AFM from other conditions:

Sudden Onset of Muscle Weakness: This usually manifests in the arms and legs but can affect any muscle group.
Facial Droop or Weakness: One side of the face may appear droopy or less responsive.
Difficulty Swallowing or Slurred Speech: As the disease progresses, it may affect muscles involved in swallowing and speech.
Eye Movement Abnormalities: AFM can lead to difficulties in controlling eye movements, causing double vision or drooping eyelids.
Respiratory Failure: In severe cases, the muscles involved in breathing can be affected, necessitating mechanical ventilation.

What Are the Causes of Acute Flaccid Myelitis?

The exact etiology of AFM remains unclear, but several factors are believed to contribute to its onset:

Viral Infections

Various viruses, particularly enteroviruses, have been implicated in triggering AFM. Enterovirus D68 (EV-D68) and Enterovirus A71 (EV-A71) are the most commonly associated viruses. These viruses can cause respiratory illnesses, which may precede the onset of AFM.

Environmental Factors

Although less understood, environmental factors could play a role in the development of AFM. Seasonal patterns have been observed, with most cases occurring in late summer and early fall.

Genetic Predisposition

There may also be a genetic component that makes certain individuals more susceptible to developing AFM. However, more research is needed to confirm this hypothesis.

When to See a Neurologist?

Acute Flaccid Myelitis can rapidly progress, causing severe limb weakness or paralysis. Early neurologist evaluation is critical to prevent permanent nerve damage and ensure timely treatment or hospital admission.

You should see a doctor if you have:

Sudden weakness or limpness in one or more arms or legs
Difficulty moving facial muscles, swallowing, or speaking
Loss of muscle tone or reflexes following a recent viral illness

Get medical help immediately if:

You or your child experiences rapid onset of paralysis or inability to breathe
There is sudden loss of bladder or bowel control alongside limb weakness
Severe neck stiffness or inability to swallow develops within hours

These could be signs of a serious complication like Acute Flaccid Myelitis, which needs urgent care.

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How is the Diagnosis of Acute Flaccid Myelitis Done?

Diagnosing AFM involves a combination of clinical evaluation, imaging studies, and laboratory tests:

Clinical Evaluation

A thorough neurological examination is the first step in diagnosing AFM. Physicians look for muscle weakness, reflex abnormalities, and other neurological signs indicative of spinal cord involvement.

Imaging Studies

Magnetic Resonance Imaging (MRI) is crucial for diagnosing AFM. MRI can reveal inflammation in the spinal cord, particularly in the gray matter, which is a hallmark of AFM.

Laboratory Tests

Laboratory tests include cerebrospinal fluid (CSF) analysis and viral testing. Elevated white blood cell count in the CSF can indicate inflammation. Viral testing helps identify potential viral triggers, although a specific virus is not always detected.

What is the Treatment for Acute Flaccid Myelitis?

Currently, there is no specific antiviral treatment for AFM. Management primarily focuses on supportive care and symptomatic relief:

Supportive Care

Supportive care is vital for managing AFM. This includes physical therapy to maintain muscle function and prevent contractures, occupational therapy to assist with daily activities, and respiratory support if breathing muscles are affected.

Medications

While there is no definitive antiviral treatment for AFM, some medications may help alleviate symptoms or manage complications. These include:

Corticosteroids: Used to reduce inflammation in the spinal cord.
Intravenous Immunoglobulin (IVIG): May help modulate the immune response.
Plasma Exchange (Plasmapheresis): A procedure that removes and replaces plasma to eliminate harmful antibodies.

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Prognosis of Acute Flaccid Myelitis

The prognosis for AFM varies widely among individuals. Some patients experience significant recovery, while others may endure long-term disabilities. Factors influencing prognosis include:

Severity of Initial Symptoms

Patients with severe initial symptoms, such as extensive muscle weakness or respiratory failure, generally have a poorer prognosis.

Timing of Treatment

Early intervention, particularly with physical and occupational therapy, can improve outcomes by preventing muscle atrophy and promoting neural recovery.

Age and Overall Health

Younger patients and those in good overall health tend to have better recovery outcomes.

Preventing Acute Flaccid Myelitis

While AFM is not entirely preventable, certain measures can reduce the risk of viral infections associated with the condition:

Good Hygiene Practices

Frequent handwashing, avoiding close contact with sick individuals, and cleaning surfaces can reduce the risk of viral infections.

Vaccination

Although there is no vaccine specifically for AFM, staying up-to-date with recommended vaccinations, including those for polio and influenza, can help prevent illnesses that might lead to AFM.