Acute Flaccid Myelitis (AFM)

Acute flaccid myelitis (AFM) is a rare but serious nerve-related condition that attacks the spinal cord and the nerves that go to the muscles.

What is Acute Flaccid Myelitis?

Acute flaccid myelitis (AFM) is a rare but serious nerve-related condition that occurs mostly in children – it is similar to polio. It comes from a virus that is the common cold. This “polio-like” illness attacks the spinal cord and the nerves that go to the muscles. Patients begin with a respiratory illness (cough and fever) and then end up with weakness. Many children are no longer able to move their arms and legs.  The condition can also involve the breathing muscles, neck muscles and the belly muscles. The Center for Disease Control first recognized AFM in 2014.  Cases have been reported in the United States and around the world and are more common every other year.

How Common is Acute Flaccid Myelitis?

AFM is a rare disease. Since 2014, there have been less than 700 confirmed cases nationwide. 

What are the Signs and Symptoms of Acute Flaccid Myelitis?

The most common symptoms of AFM include:

  • Fever
  • Cough 
  • Weakness in the arms or legs
  • Signs of paralysis may be seen later on

In some cases, children with AFM may have pain in the arms or legs. AFM can also affect the nerves controlling the head and neck which can cause facial weakness, drooping of the eyelids, and difficulty swallowing, speaking or moving the eyes.

In very rare cases, children’s lungs may stop working if the muscles involved with breathing become weakened.

What Causes Acute Flaccid Myelitis?

While the reason certain children develop AFM is still unclear, it typically occurs following a viral infection that causes the common cold (Enterovirus D68, Coxsackie Virus and others).  However, it is still unknown how or why these infections trigger AFM symptoms in some patients.

How is Acute Flaccid Myelitis Diagnosed?

Patient history is very important for diagnosis of AFM. The doctor will want to know if your child has had a recent cold such as a fever, cough or upset stomach.

A detailed physical exam is very important, but the MRI of the spine is usually used to diagnosis AFM and lab tests of the cerebral spinal fluid (CSF) and blood may be performed and can also help make the diagnosis of AFM.

Inside the OR with Kim Bjorklund, MD

Join us inside the operating room with Kim Bjorklund, MD, director of the Brachial Plexus Program at Nationwide Children's Hospital. "I think there’s just something really special about kids and I think being able to work with them every day, it makes my life better," says Dr. Bjorklund.

Watch the Video

How is Acute Flaccid Myelitis Treated?

There is no established medical treatment or medications to cure AFM. At first, patients are treated with supportive care including hospital admission, medications such as steroids and treatments that include plasmapheresis and/or IVIG. Physical therapy and occupational therapy is very important. Kids often spend weeks to months in therapy programs. Children with AFM require treatment by a multidisciplinary team for best outcomes.

If muscle movement does not come back a surgical procedure can be performed to help. These are called nerve transfers. A nerve transfer involves finding a healthy working nerve and connecting it to a non-working muscle. In time, the working nerve grows into the muscle and over time (9-12 months) movement can happen. This helps to rewire the nerves to give children better movement and strength in their limbs.

Our surgical team includes Amy Moore, MD, and Kim Bjorklund, MD. Both surgeons have been on the front line with performing nerve transfers to restore function for both in arms and legs. Dr. Moore was the first to describe nerve transfer interventions for AFM patients with lower extremity involvement and has evaluated and treated over 50 patients with AFM since 2017. Together with Dr. Bjorklund, the surgical team has the experience and expertise to improve lives in patients with AFM.

At Nationwide Children’s, our multi-disciplinary team provides comprehensive care for patients with AFM. We are committed to providing cutting edge treatments to improve the outcomes and quality of life in our patients.