Does a child suddenly lose their limbs? Let's learn about this rare disease (Acute Flaccid Myelitis)

Imagine your little one running around and playing, and suddenly one of their arms or legs seems to be paralyzed. Or their limbs are so weak that they can't even stand up straight. Seeing something like this would scare any parent. Today we're going to talk about a rare but very serious neurological condition that can occur suddenly. This is Acute Flaccid Myelitis, or AFM for short.

What exactly is Acute Flaccid Myelitis (AFM)?

Simply put, AFM is a serious condition that affects our nervous system. It causes inflammation, or swelling, in the gray matter of our spinal cord.

Now you may be wondering what this gray matter is. Think of our body as a complex electrical circuit. The brain and spinal cord are the main control room of this. The gray matter in this control room is the main place that sends signals that control the movements of our muscles. So when this important place is damaged in AFM, the signals sent from the brain do not go to the muscles properly. As a result, the limbs suddenly become weak, numb, and reflexes are lost.

This is a relatively new disease. Doctors identified it as a separate disease in 2014. Before that, when symptoms like this appeared, doctors thought it was another neurological disease like ``transverse myelitis''.

What is the difference between AFM and Guillain-Barré Syndrome (GBS)?

Another disease that many people confuse with AFM is `Guillain-Barré Syndrome` (GBS for short). The main symptom of both of these diseases is muscle weakness. But the two are completely different. Let's see what those differences are.

Imagine that our nervous system is like a network that distributes electricity throughout the country.

• In AFM, damage occurs to: the main powerhouse of this network, the gray matter in the spinal cord. When the powerhouse itself is damaged, it cannot produce and transmit electricity.
• GBS damages: The wires that carry electricity from the power plant to homes. We call these peripheral nerves. When the wires are damaged, even though electricity is sent from the power plant, it doesn't reach homes properly.

Simply put, AFM is a problem of the central nervous system . GBS is a problem of the peripheral nervous system .

There is also a difference in the way these symptoms spread.

• In GBS: Weakness usually starts in the legs and then gradually moves up the body.
• In AFM: Weakness can start anywhere, perhaps in one arm, or even in both legs.

Another important thing is the age group in which this disease occurs most often. 90% of AFM patients are young children between the ages of 1 and 7. However, it can rarely occur in adults. GBS, however, is most commonly seen in adults over the age of 40.

How common is this disease? Who is most likely to get it?

AFM is a very rare condition. Even in a country like the United States, it is estimated that less than one in a million people develop the disease each year. However, there has been a slight increase in the number of cases reported recently.

As we mentioned earlier, this disease is most common in young children . Children under the age of 7 are especially at risk. Since this can happen to children, it is important for us as parents to be aware of this.

What are the symptoms of AFM?

The most dangerous thing about this disease is that the symptoms come on very suddenly . These symptoms can appear within a few hours or a few days. If your child has these symptoms, don't ignore them.

What is the reason for this?

This is the question that doctors still can't figure out. We're still not 100% sure what the exact cause of AFM is.

However, many researchers and doctors suspect that a type of virus is involved . There is a strong suspicion that viruses in the `non-polio enteroviruses` group may be the cause.

Remember, before AFM symptoms appear, many children have a respiratory infection, such as a common cold, fever, and cough . This further increases the suspicion that there is a viral connection. In particular, the viruses `Enterovirus D68` and `Enterovirus A71` have been identified in many AFM patients.

How does a doctor accurately diagnose this disease?

Diagnosing AFM is a bit of a challenge because it's rare and has very similar symptoms to other neurological diseases like GBS, transverse myelitis, and polio, which we discussed earlier.

Therefore, the doctor will have to do several tests to confirm whether this is AFM or another disease.

• Physical examination and neurological examination: First, the doctor will examine the child carefully. They will check for weakness in the limbs, the condition of the muscles, and how the reflexes are.
• MRI scan: This is the most important and useful test for diagnosing AFM. An MRI scan of the brain and spinal cord can clearly show the changes, such as inflammation, that are characteristic of AFM in the gray matter of the spinal cord.
• Spinal Tap/Lumbar Puncture: This involves inserting a small needle into the lower back and removing a small amount of the fluid around the spinal cord (cerebral spinal fluid - CSF). This fluid can be tested to see if there is an infection or inflammation.
• Testing nerve and muscle function: Special tests may be done, such as nerve conduction studies, which measure the speed at which signals travel through nerves, and electromyography, which measures the electrical activity of muscles.

The doctor comes to a final conclusion by combining the information obtained from all these tests.

Is there a treatment for AFM?

Unfortunately, there is no definitive treatment that can completely cure AFM. Because it is a new disease, doctors and scientists are still researching the best treatment for it.

Therefore, the main goal of treatment is to control symptoms and help the child recover as best as possible.

• Physical Therapy and Occupational Therapy: This is an essential part of treatment. These therapies help to exercise weakened limbs, rebuild muscle strength, and train the child to do tasks independently.
• Other treatments: In some cases, things like peripheral nerve surgery have been shown to be successful in preventing muscle wasting. However, a neurologist will decide whether these are appropriate for each patient.

If possible, it is best to seek treatment under a neurologist who has experience with this disease.

What is the prognosis of the disease and possible complications?

Because AFM is a new disease, researchers still can't say exactly what the long-term consequences will be once it occurs. But based on what is known, outcomes can vary greatly from person to person.

• Slow recovery: Many children, with ongoing treatment such as physical therapy, gradually recover to some extent over time. Muscle strength gradually increases.
• Complete recovery: Less than 10% of AFM patients make a complete recovery. Many may continue to have some degree of weakness.

Possible serious complications

• Respiratory Failure: This is the most dangerous complication we discussed earlier. If the muscles that help with breathing weaken, the patient will be unable to breathe on their own. At that point, they will need to be connected to a ventilator. This condition occurs in about a third of AFM patients.
• Other neurological complications: Serious, life-threatening complications such as abnormal changes in body temperature and blood pressure, and irregular heartbeat are also possible.

Is there a way to avoid this?

Since the exact cause of AFM is unknown, there is no specific way to prevent it. However, since it is mainly suspected to be caused by viral infections, it is very important to follow the health habits we generally follow to avoid viruses.

• Wash your hands regularly with soap and water. Teach your children to wash their hands thoroughly, especially before eating, after using the bathroom, and after caring for a sick person.
• Avoid touching your face, eyes, nose, and mouth with unwashed hands.
• Stay away from people who are sick.
• Give your child all the vaccinations they need at the right age.
• Clean frequently touched surfaces (doorknobs, tables) with disinfectant.

These simple health habits can protect our children from not only AFM, but many other infectious diseases.

Acute Flaccid Myelitis, AFM, amputations in children, neurological diseases, viral infections, spinal cord, emergency care