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As if worrying about the coronavirus isn’t enough, the Centers for Disease Control and Prevention (CDC) is warning of a particularly severe season of acute flaccid myelitis (AFM) in 2020. A mysterious polio-like illness affecting mostly children, AFM is a rare but serious neurologic condition causing weakness in the arms or legs. Thought to be caused by enteroviruses, the disease has spiked every two years in the U.S. between August and November since 2014.
The CDC anticipates 2020 to be another peak year for AFM — especially because of its overlap with COVID-19. “Recognition and early diagnosis are critical,” CDC Director Dr. Robert Redfield said in a statement.
Neurologist Dr. Riley Bove knows the seriousness of the condition firsthand. Her 4 year-old son was diagnosed in 2014 with AFM after developing symptoms following a seemingly normal 10 day cold. Bove described her son's experience to the New York Times, as “head-to-toe paralysis, where he could kind of move his eyes a little bit and one side of his face.”
What is acute flaccid myelitis (AFM) and what are symptoms to look out for?
AFM is a condition that specifically affects the area of the spinal cord called gray matter, causing a sudden loss of muscle tone and reflexes. It can be considered a syndrome because it is a pattern of symptoms. Over the course of hours or days, AFM can progress swiftly in previously healthy people and lead to permanent paralysis and/or life-threatening respiratory failure.
On the rise since 2014, AFM cases have increased in the U.S. every two years, with 120 in 2014, 153 in 2016, and 238 in 2018. More than 90% of AFM cases have been in young children, with the average age being 5.
Symptoms of AFM
The main symptoms of AFM that most people experience are:
- Arm or leg weakness
- Loss of muscle tone and reflexes
Other warning signs may be:
- Recent or current respiratory illness
- Fever
- Drooping eyelids or difficulty moving eyes
- Facial droop or weakness
- Difficulty talking or swallowing
- Slurred speech
- Arm or leg pain or numbness
- Neck pain or weakness
- Back pain
- Gait difficulty
In rare cases, some people experience:
- Numbness or tingling
- Being unable to urinate
On occasion, AFM can weaken the muscles needed for breathing to the point of respiratory failure, possibly needing a ventilator to help you breathe. In addition, there can be life threatening body temperature changes and blood pressure instability. If you are experiencing any combination of these symptoms, contact your pediatrician immediately.
What causes AFM and is there a cure?
Though experts aren’t exactly sure what causes AFM, recent studies suggest AFM may originate from enteroviruses, which are a group of RNA viruses that include the polio and hepatitis A viruses. Enteroviruses typically affect the gastrointestinal tract and sometimes, like in the case of AFM, spread to the central nervous system or other parts of the body.
Can I prevent my child from contracting AFM?
As of now, there are no acute flaccid myelitis vaccines, no specific AFM tests, and no proven treatments or prevention methods for AFM. This seems terrifying, but many children become infected with enteroviruses every year without contracting AFM.
Though there are currently no proven prevention methods for acute flaccid myelitis, because the disease usually follows a virus, doctors advise teaching your kids the same methods you use to avoid the coronavirus and getting sick in general.
- Practice good hand hygiene
- Avoid touching your eyes or mouth
- Cover your mouth and nose when coughing or sneezing
- Avoid sick people
- Clean and disinfect surfaces
What to do if you think your child has AFM
At the moment, it is unknown how the pandemic and social distancing may affect circulation of the viruses suspected to cause AFM. Additionally, it is uncertain how COVID-19 will impact both the health care system’s ability to diagnose or respond to AFM. According to the CDC, even if you live in an area with high COVID-19 activity, if you or your child develop any of the symptoms, seek medical care immediately.
AFM diagnosis
Doctors can determine if your child has AFM by:
- Reviewing their medical history
- Check for places on the body with weakness, poor muscle tone, and diminished reflexes
- Perform an MRI to examine the brain and spinal cord
- Conduct lab tests on the fluid surrounding the brain and spinal cord
- Check how the nerves conduct impulses and respond along the nerve fiber
AFM can be difficult to diagnose because many symptoms overlap with other neurologic conditions like transverse myelitis and Guillain-Barre syndrome. However, if doctors can diagnose AFM early enough, neurologists may advise treatments on a case-by-case basis such as physical or occupational therapy to help with weakness in the limbs.
Keep it in perspective
Lisa Coyne, a clinical psychologist at Harvard Medical School, cautions against worrying excessively about your child contracting AFM, as it is very rare. During this pandemic, “stress and anxiety these days are fellow travelers with us,” she told the New York Times. Coyne, who has written about managing anxiety during COVID, suggests keeping the symptoms in mind but don't obsess about the possibility of your child getting AFM.
