Children's Hospital Colorado

Acute Flaccid Myelitis (AFM) in Pediatrics (S2:E35)

Acute flaccid myelitis (AFM) is a rare but serious condition. News of the condition strikes fear into the hearts of parents and providers alike. AFM affects the nervous system, specifically the gray matter of the spinal cord. The result is a presentation of flaccid paralysis symptoms. This condition is not new. Still, the symptoms may be new to some physicians.

AFM primarily affects children. It often manifests as hand, foot and mouth disease. Aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis and other severe systemic disorders are also commonly associated with AFM.

Experts believe that AFM is most often caused by viruses. Enterovirus D68 (EV-D68), a member of the polio family, is the most likely culprit behind AFM cases in the United States. Some people have already named this virus the “new polio.”

Listen to pediatric medical experts discuss the diagnosis and treatment of AFM

In today’s episode we are joined by Kevin Messacar, MD. He’ll explain the common presentations and treatments for enterovirus infections, specifically AFM.

Dr. Messacar is an infectious disease specialist and hospitalist at Children’s Hospital Colorado. He is also an assistant professor of pediatrics at the University of Colorado School of Medicine. He has been involved in clinical research on the linkage of enteroviruses to AFM since it was first identified in Colorado in 2014. Additionally, he works with the Centers for Disease Control and Prevention (CDC) to further investigate the role of enterovirus in AFM.

Please note that Dr. Messacar's interview in this episode is expressly his own. Any opinions are not expressed on behalf of the professional organizations he serves.

In today’s episode, our expert explains:

  • The presenting symptoms of AFM and what the onset of neurological symptoms looks like
  • Specific symptoms that might suggest underlying AFM and why return precautions are necessary
  • The drivers behind the seasonal biennial patterns of AFM and the role of EV-D68
  • How a practitioner should approach a child with suspected AFM
  • The specimens required to make an accurate AFM diagnosis
  • Various treatments for AFM, how they work and the specific areas that still lack efficacy
  • The need for researchers to confirm the predominant cause of the disease
  • The progress of ongoing efforts to develop a vaccine
  • What the long-term prognosis looks like for pediatric AFM patients
  • The unfortunate possibility of permanent paralysis in children who suffer from AFM
  • Why a new wave of AFM is predicted for 2020
  • What can be done to prepare for and prevent another AFM outbreak
  • The benefits of the AFM task force instituted by the CDC
  • Where to find investigation updates and more information about what the CDC is doing at the public health level
  • How AFM affects other countries, the incidence rate and the problem with underreporting
  • The difference between EV-71 and EV-D68 in terms of long-term paralysis

Treating acute flaccid myelitis (AFM) at Children’s Colorado

Children's Colorado doctors recognized the first cluster of AFM in 2014 and were able to study the virus with colleagues from the University of Colorado School of Medicine. We serve patients through the region’s most experienced AFM research and treatment team and are a major referral center for the seven-state region. Refer a patient to Children’s Colorado.