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Mystery virus causing paralysis? What parents need to know.

November 29, 2018

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By Danielle Leivian, M.D.

Danielle Leivian, M.D.Another day, another disease to worry about, right? In between “reasons my child is crying” memes, there’s a good chance that your news feed has been highlighting a scary type of childhood paralysis called Acute Flaccid Myelitis.

What is Acute Flaccid Myelitis?

There we go with the med-speak again. Acute Flaccid Myelitis, or AFM, is a descriptive term for a medical condition that is still shrouded in mystery. Acute simply means sudden in onset. Flaccid refers to the “limp muscle” type of paralysis that we see in diseases that affect the spinal cords or motor nerves exiting the spinal cord. Myelitis refers to inflammation in the spinal cord.

AFM is a curious disease. There were rare reports of it before this decade, but in 2014, it sprang onto the scene and numbers have flared up every 2 years since. We aren’t sure what causes it yet, but it seems to cycle with peak occurrence during late summer and early autumn. It happens almost exclusively in children and teens.

The vast majority of afflicted kids have had cold symptoms (cough, runny nose, fever) during the prior week and some AFM patients test positive for viruses in their spinal fluid. This suggests that certain viral infections may trigger AFM. The CDC has some leads, but is casting a wide net and has not ruled out the possibility of an environmental or toxic cause.

When should I worry?

While AFM cases are increasing, it’s very important to understand that this is still an incredibly rare disease. There have been 430 confirmed cases in the US since 2014 and 106 confirmed cases this year. This disease happens to fewer than 1 out of 1 million children.

Here’s what to watch for:

  • Sudden onset of weakness in an arm and/or leg on one side of the body.
  • Facial droop, difficulty with eye movement, drooping eyelids, swallowing difficulty, or slurred speech may also occur.
  • Numbness and tingling is rare, although some patients report limb pain.
  • In rare and severe cases, AFM may affect the respiratory muscles and cause breathing problems.

If your child has any of these symptoms, they should be seen in clinic (or the ER if they are having breathing problems). Workup typically involves blood work, spinal cord imaging, and possibly a lumbar puncture (spinal tap). Treatment is typically determined on a case-by-case basis and would likely be led by a pediatric neurologist.

Can AFM be prevented?

We do not yet have a sure-fire way to prevent AFM, but for now, wash your hands well and frequently, protect your family from influenza with yearly flu vaccines, and try to share holiday meals rather than winter germs. Rest easy by remembering that while virtually all kids will get a cold (or 10 of them) this fall and winter, exceedingly few will get AFM. Let us know if you have questions!