A Handle on your Health
Acute flaccid myelitis (AFM) affects the spinal cord and causes sudden muscle weakness. Currently the Centers for Disease Control are investigating over 120 cases of suspected AFM across the country. This is the fourth year to see spikes in cases of this disease, yet the cause of AFM, for now, is a mystery.
Symptoms of AFM
It is mainly muscle weakness caused by inflammation of the grey matter in the spinal cord. The inflammation disrupts the transmission of signals to muscles causing the muscles to become weak and even lose their reflexes. The weakness initially presents in the face, limbs or bladder. Because AFM predominantly involves the motor system and not the sensory system, symptoms do not necessarily include pain, numbness or tingling.
If symptoms begin in the face, a patient may present similar to Bells Palsy with facial droop and may also involve throat muscles effecting speech or swallowing. If symptoms initially present in the limbs, weakness will make it difficult to lift simple objects or walk. The limbs can be affected on one side or both. Limbs may become so flaccid that the patient cannot move the affected limb. Occasionally patients present with an inability to empty their bladder.
Diagnosing AFM
There is no specific test as of yet that can be performed to diagnose AFM. Most patients present to an area Emergency Department and may receive a blood test, MRI, spinal tap or nasal swab to examine the patient’s blood, brain and spinal fluid. Most presenting children seem to have had a febrile illness in the two weeks prior to developing AFM. Physical examination will show a limb that is so flaccid that if lifted it literally just falls back to rest.
The occurrence of AFM seems to peak in September and October and is difficult to diagnose because it can present like transverse myelitis, Guillain-Barre syndrome or, as mentioned previously, Bells Palsy.
Preventing AFM
Unfortunately, we do not yet understand how this disease is transmitted. Perhaps it is an infection involving viruses such as Polio or the West Nile virus. Some doctors speculate that it may be related to environmental toxins or a genetic disorder. Doctors at Johns Hopkins Medical Center have suggested AFM may actually be caused by the immune system attacking the spinal cord after reacting to an environmental agent or a virus. The CDC is recommending universal precautions for now. Good hygiene, such as frequent hand washing should reduce the spread of AFM if it is caused by an infectious agent.
Treatments for AFM
Currently we do not know of any specific treatment for AFM. Neurologists are hopeful that some of the treatments for transverse myelitis may be therapeutic. Recommendations are to begin physical therapy as soon as practical. If symptoms are mild, then it appears recovery is faster and better than when symptoms are severe. In severe cases the symptoms may last for years and it remains unclear what the long-term prognosis is.
What’s the take home message for Hays County? This is a rare disease and so when a child develops a fever it is not necessary to rush to the nearest Emergency Room for evaluation. Remember, common illnesses are common. So if your child has what appears to be a "cold" then it is probably just a cold. There have only been a couple of cases of AFM reported in Texas this year. But, if your child suddenly has trouble lifting their arms or legs or they have difficulty swallowing or breathing, then you should take your child to be evaluated by a medical professional.
We all love our children very much and would do anything to protect them. While acute flaccid myelitis is a scary disease, it is rare and unlikely to affect kids here in Texas. That’s good news for us here in Hays County.
If you see symptoms like AFM in a child, do not hesitate to get them checked out.
For anyone currently experiencing any kind of illness that is going around, take care of yourself and, until next time, feel better.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
