Acute Flaccid Myelitis: A New Treatment Option for AFM

Acute flaccid myelitis, or AFM, is not a new disease, but most people have never heard of it. Those who have, may have heard of a mysterious polio-like illness affecting children in recent news coverage. AFM is a serious condition that affects the nervous system, causing weakness and paralysis in muscles.

Thankfully, new treatments are being studied as doctors and scientists are learning more about AFM.

What is AFM?

AFM affects the spinal cord and may lead to sudden weakness in the arms or legs. Occasionally, it can also affect the eyes and face and may be associated with trouble speaking, swallowing or breathing. The amount and location of weakness is different for everyone. Unfortunately, this muscle weakness doesn’t always go away on its own, leaving children permanently weak or paralyzed.

Although it can cause symptoms like polio, AFM is a separate condition with no known cause. However, most people with AFM had a respiratory virus or flu of some sort before developing AFM.

According to the Centers for Disease Control and Prevention, it’s rare — affecting less than two in every one million kids — but it’s symptoms and long-term effects can be scary and debilitating, and cases are on the rise in young children.

How Is AFM Treated?

Physical therapy is critical and can help some kids regain or improve muscle movement. Often, physical therapy will be needed for a long time.

There is no set medicine for AFM yet, but some children are given treatments used for a similar condition, called classic transverse myelitis. These may include steroids, plasma exchange and other treatments to try to keep the body from attacking itself. It’s not yet known if these work for AFM, so each child is treated uniquely.

New Nerve Surgery for AFM

When kids don’t regain functional movement in the upper extremities, we may still be able to help. Kids with AFM are often treated by a multidisciplinary team to help them get the best outcomes. As a hand and arm surgeon, I work on tiny nerves and blood vessels. I even do surgery on vessels smaller than one mm — about the width of a grain of sand!

Surgery for AFM involves transferring tiny nerve branches from healthy branches to those affected by the disease. This helps “rewire” or regenerate things so that kids can move their limbs better. It doesn’t always give children totally normal function, but it can help gain more movement and strength. This is similar to the microvascular surgery we do for children with brachial plexus injuries — an injury from birth causing arm weakness or paralysis.

To experience the best overall outcomes, it is critical that kids have ongoing care by Physical Medicine and Rehabilitation specialists who can help them adapt and maximize their potential function. 

As we learn more about AFM, we hope the physical medicine and surgery options will grow, and that we will find a cure. Until then, our multidisciplinary team of physical medicine and rehabilitation doctors, occupational and physical therapists and hand and upper extremity surgeons will be hard at work to try to restore motion and strength to AFM-affected limbs.

To learn more about the Hand and Upper Extremity Program at Nationwide Children’s Hospital, click here.