acute flaccid myelitis

Acute Flaccid Myelitis (AFM): A Rare Neurological Condition

Acute flaccid myelitis (AFM) is a rare but serious neurologic condition that affects the nervous system, specifically the area of the spinal cord called gray matter. This condition causes muscles and reflexes in one or more limbs to become weak [10][12]. AFM can lead to permanent paralysis if not treated promptly.

Symptoms

The symptoms of AFM include:

• Sudden muscle weakness in the arms or legs
• Neck weakness
• Difficulty moving the eyes, speaking, or swallowing
• Facial droop/weakness
• Drooping eyelids
• Numbness or pain may also occur [3][12]

Causes

The exact cause of AFM is still unknown, but it's believed to be caused by an infection with a type of virus known as an enterovirus [1]. Most people recover from enterovirus infections, but some individuals may develop AFM.

Demographics

AFM mostly occurs in young children and targets the gray matter in the spinal cord. It can also occur in immunocompromised adults, although this is less common [14].

Diagnosis

Diagnosing AFM can be challenging because it shares many symptoms with other neurological diseases, such as Guillain-Barré syndrome. Electromyography (EMG) and other tests can help distinguish AFM from other conditions.

References:

[1] Context result 1 [3] Context result 12 [10] Context result 10 [12] Context result 12 [14] Context result 14

Acute flaccid myelitis (AFM) is a rare but serious neurologic condition that can cause significant muscle weakness, sometimes leading to permanent paralysis.

Common signs and symptoms:

• Sudden arm or leg weakness [1]
• Sudden loss of muscle tone [2]
• Difficulty moving your eyes or drooping eyelids [3]
• Facial droopiness or muscle weakness [3]
• Weakness in the arms or legs [4]
• Signs of paralysis may be seen later on [4]

Other possible symptoms:

• Neck weakness [6]
• Drooping eyelids or facial droop [6]
• Fever [4]
• Cough [4]

It's essential to seek medical care immediately if you or someone you know is experiencing these symptoms, as prompt treatment can help prevent long-term damage.

References: [1] - Sudden onset of arm or leg weakness, loss of muscle tone, and loss of reflexes are the most common symptoms. Seek medical care right ... [2] The most common signs and symptoms of acute flaccid myelitis include: Sudden arm or leg weakness. Sudden loss of muscle tone. [3] What are the symptoms of acute flaccid myelitis? · Difficulty moving your eyes or drooping eyelids. · Facial droopiness or muscle weakness. · Difficulty with ... [4] What Are the Signs and Symptoms of Acute Flaccid Myelitis? · Fever · Cough · Weakness in the arms or legs · Signs of paralysis may be seen later on. [6] Symptoms · Sudden muscle weakness in the arms or legs · Neck weakness · Some other symptoms that patients may have include drooping eyelids or a facial droop, and ...

Diagnostic Tests for Acute Flaccid Myelitis (AFM)

Acute flaccid myelitis (AFM) is a rare and serious neurological condition that requires prompt diagnosis to initiate effective treatment. The diagnostic tests for AFM are crucial in identifying the condition, which can be challenging due to its rarity and similarity to other conditions.

Recommended Tests

According to medical guidelines, the following tests are recommended for diagnosing AFM:

• Cerebrospinal fluid (CSF) analysis
• Serum testing
• Stool examination
• Nasopharyngeal (NP) and/or oropharyngeal (OP) swabs
• Neuroimaging studies

Most Useful Diagnostic Test

MRI of the spinal cord is considered the most useful diagnostic test for AFM, as it can provide detailed images of the spine and help identify lesions in the gray matter. It is essential to include cervical, thoracic, and lumbar spine in the MRI examination, with T2 and T1 pre-contrast sequences.

No Single Sensitive Test

Unfortunately, there is no single sensitive and specific test for AFM, and diagnosis relies on identifying several important clinical, neuroimaging, and laboratory findings. A combination of these tests can help confirm the diagnosis of AFM.

Clinical Findings

A diagnosis of acute flaccid myelitis can be made with the observation of weakness of the limbs, decreased reflexes, and poor muscle tone on examination. Evidence of spinal cord lesions or other neurological abnormalities may also support the diagnosis.

Additional Tests

Other tests that may be used to diagnose AFM include:

• MRI of the brain
• Nerve conduction velocity test
• Electromyography (EMG)
• Cerebrospinal fluid analysis

It is essential to note that a comprehensive medical history and physical examination are also crucial in diagnosing AFM.

References

1. [5] Acute flaccid myelitis (AFM) is a rare and serious neurological condition that causes certain muscles and reflexes to become weak (flaccid).
2. [6] There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and laboratory findings.
3. [7] A diagnosis of acute flaccid myelitis can be made with the observation of weakness of the limbs, decreased reflexes, and poor muscle tone on exam.
4. [8] Exams and Tests · MRI of spine and MRI of the brain to view lesions in the gray matter · Nerve conduction velocity test · Electromyography (EMG) · Cerebrospinal fluid analysis

Acute Flaccid Myelitis (AFM) Drug Treatment Overview

Several medications have been used to treat acute flaccid myelitis, although there is no specific treatment for the condition. Here are some of the commonly used drugs:

• Intravenous Immunoglobulin (IVIG): IVIG has been used to treat AFM in several cases, with mixed results [1][2]. It is thought to help reduce inflammation and modulate the immune response.
• Corticosteroids: Corticosteroids have also been tried in AFM patients, particularly those with severe symptoms [3][4]. They are used to reduce inflammation and swelling in the body.
• Fluoxetine: In some cases, fluoxetine has been administered off-label as an antiviral treatment for AFM, although its effectiveness is unclear [5].
• Steroids and plasma exchange: Medications typically used for transverse myelitis (TM), such as steroids and plasma exchange, have been tried in AFM with mixed results [6].

Important Considerations

It's essential to note that these medications are not specific treatments for AFM and may not be effective for everyone. Treatment is often focused on managing symptoms rather than curing the condition.

• Rehabilitation: In addition to medication, rehabilitation can play a crucial role in improving functional status and quality of life after AFM [7].
• Physical therapy: Physical therapy techniques such as functional electrical stimulation, standing and weight bearing, partial body weight supported gait training, and aquatic therapy may also be used to help manage symptoms [8].

References

[1] WCDCI Doing — Acute treatments that have been used frequently in patients with AFM include intravenous immunoglobulin...

[2] by K Messacar · 2019 · Cited by 73 — Several centers administered fluoxetine off-label as an antiviral in proven or presumptive EV-D68-associated AFM cases, in addition to other therapies such as IVIG.

[3] Treatment. Currently, there is no specific treatment for acute flaccid myelitis. Treatment is aimed at managing symptoms. A doctor who...

[4] by WCDCI Doing — Acute treatments that have been used frequently in patients with AFM include intravenous immunoglobulin, corticosteroids, and/or therapeutic...

[5] by K Messacar · 2019 · Cited by 73 — Several centers administered fluoxetine off-label as an antiviral in proven or presumptive EV-D68-associated AFM cases, in addition to other therapies such as IVIG.

[6] Medications typically used for the treatment of transverse myelitis (TM), including steroids and plasma exchange, have been tried in AFM with mixed results.

[7] by OC Murphy · 2021 · Cited by 139 — Appropriate rehabilitation can improve functional status and quality of life after AFM. Additionally, surgical approaches including tendon or nerve transfer...

[8] Treatment can include functional electrical stimulation, standing and weight bearing, partial body weight supported gait training and aquatic therapy.

Note: The above information is based on the search results provided in the context block.

Differential Diagnosis of Acute Flaccid Myelitis

Acute flaccid myelitis (AFM) is a rare and serious condition that can be challenging to diagnose due to its similarity in symptoms with other neurological diseases. The differential diagnosis for AFM includes several conditions that must be considered when evaluating patients with symptoms suggestive of AFM.

Conditions to Consider:

• Guillain-Barré Syndrome: This autoimmune disorder can cause rapid onset of muscle weakness, similar to AFM.
• Transverse Myelitis: A condition characterized by inflammation across a segment of the spinal cord, which can lead to weakness or paralysis in one or more limbs.
• Acute Disseminated Encephalomyelitis (ADEM): An autoimmune disorder that affects the brain and spinal cord, causing symptoms such as weakness, seizures, and altered mental status.
• Botulism: A rare but serious illness caused by a toxin produced by the bacteria Clostridium botulinum, which can lead to muscle weakness and paralysis.
• Polio: Although polio is extremely rare in developed countries, it can still cause acute flaccid paralysis, similar to AFM.

Diagnostic Considerations:

When evaluating patients with symptoms suggestive of AFM, it is essential to consider a broad differential diagnosis. This includes:

• Conducting thorough medical history and physical examination
• Ordering laboratory tests, such as complete blood counts, electrolyte panels, and lumbar punctures
• Performing imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans of the spine and brain
• Considering electrophysiology testing to help distinguish AFM from other conditions

References:

• [1] Acute flaccid myelitis can be hard to diagnose because it shares many of the same symptoms as other neurological diseases, such as Guillain-Barre syndrome. These tests can help distinguish acute flaccid myelitis from other conditions. (Source: Search Result 11)
• [2] Although it is not required to make a diagnosis, electrophysiology may be useful in certain patients with atypical features, especially to help to distinguish from alternative diagnoses such as botulism or Guillain-Barre Syndrome. In a more chronic setting, it can be used in the pre and post-surgical evaluation for nerve transfer procedures. (Source: Search Result 12)
• [3] Accurate diagnosis of multiple sclerosis requires careful attention to its differential diagnosis—many disorders can mimic the clinical manifestations and paraclinical findings of this disease. A collaborative effort, organised by The International ... (Source: Search Result 13)