Acute Flaccid Myelitis (AFM) is a rare disease that affects the nervous system and causes muscle weakness and paralysis. The disease is often found in children, and in 2018, there were 11 confirmed cases in Minnesota.

Since the initial onset of those cases, Heidi Moline, MD, a pediatric chief resident at the University of Minnesota, has been working diligently to better understand and treat the disease. While the disease is uncommon, clinicians, scientists and researchers have been aware of its recurring presence. 

Previously, AFM has occurred in seasonal patterns, typically during the months of late summer and early fall. Prevention is challenging, but Dr. Moline and others with University of Minnesota Physicians suspect that AFM is correlated with the prevalence of enterovirus. There are many– over 80– strains of enteroviruses that typically cause benign, self-limited illnesses in children. But some strains of the virus can cause more serious complications. Notably, the virus that causes polio– a disease also classically associated with paralysis– is also an enterovirus, but today is prevented by universal immunization.

“A lot of cases seemed to be caused by enterovirus D68, which is spread like the common cold. Therefore, handwashing and covering your mouth while coughing and sneezing may help prevent it,” says Dr. Moline. 

The first symptom of AFM is weakness in a limb, and the current guidelines for treatment are broad. Patients who receive immediate physical therapy can experience a positive difference, and some therapies may prevent the progression of paralysis, but there has not been a specific antiviral treatment that’s demonstrated a significant impact on a patient’s outcome.

“Some of these children recover quickly and only have weakness for a short period of time. However, others have significant disabilities that dramatically impact their lives,” says Dr. Moline. “It is hard to know, and we can’t anticipate the extent of recovery in children diagnosed with AFM.”

AFM poses a significant challenge for physicians, but pediatricians are getting better at recognizing and responding to it.

“We have been really lucky this year that there has only been one confirmed case in Minnesota so far, which is what we expected with last year being such a big year,” says Dr. Moline. “I expect that fall of this year will be busy.”

Mark R. Schleiss, MD, professor in the department of pediatrics and clinician in the division of pediatric infectious diseases and immunology, has published with Dr. Moline about AFM in the past and has a National Institutes of Health grant to provide resources for the study of future AFM outbreaks. 

“If clinicians in Minnesota encounter cases of AFM in 2020”, Dr. Schleiss noted, “they should contact us immediately, to discuss potential options for new, novel therapies for this potentially devastating infection”. 

The Division of Pediatric Infectious Diseases can be reached at 612.624.1112.