Materiały źródłowe

• #1 Acute flaccid myelitis (AFM) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-flaccid-myelitis/symptoms-causes/syc-20493046

  Acute flaccid myelitis (AFM) is a rare but serious condition that affects the spinal cord. It can cause sudden weakness in the arms or legs, loss of muscle tone, and loss of reflexes. The condition mainly affects young children. […] If you or your child develops symptoms of acute flaccid myelitis, seek immediate medical care. Symptoms can progress rapidly. Hospitalization is needed and sometimes a ventilator is required for breathing support. […] Muscle weakness caused by acute flaccid myelitis can continue for months to years. […] There’s no specific way to prevent acute flaccid myelitis. However, preventing a viral infection can help reduce the risk of developing acute flaccid myelitis.

• #2 Acute Flaccid Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK606127/

  Acute flaccid myelitis (AFM) is a rare but serious neurological condition that primarily affects the spinal cord, leading to sudden muscle weakness and loss of reflexes. […] Early diagnosis and treatment are crucial, as the condition can progress rapidly, potentially leading to long-term disability. […] Participants in this course gain critical knowledge on the early recognition and diagnosis of AFM to initiate prompt treatment and minimize long-term complications. […] Emphasis is placed on the importance of an interprofessional healthcare team (including neurologists, infectious disease specialists, pediatricians, physical therapists, and occupational therapists), in providing comprehensive care for patients with this condition. […] This collaborative approach enhances patient outcomes by ensuring coordinated care, timely interventions, and support for affected patients and their families, ultimately reducing morbidity and mortality associated with AFM.

• #3 Acute flaccid myelitis (AFM) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/acute-flaccid-myelitis-afm

  Acute flaccid myelitis (AFM) is a polio-like illness that affects the nerve cells (motor neurons) in the gray matter of the spinal cord. […] Children with AFM have acute (rapid) onset of flaccid (floppy) paralysis, usually in an arm or leg. […] The key to treatment of AFM is early initiation of physical and occupational therapy (PT and OT). Early intervention may begin to restore function to affected limbs and improve daily functioning, even if it is not possible to regain full muscle function. […] Patients can continue to improve with PT and OT months to years following their initial illness. […] At the Pediatric Multiple Sclerosis (MS) and Neuroinflammatory Disorders Clinic, you have access to a large team of experts. Our neurologists and nurses specialize in caring for children with multiple sclerosis and neuroinflammatory disorders.

• #4 Acute flaccid myelitis (AFM): What parents need to know – Boston Children’s Answers

  https://answers.childrenshospital.org/acute-flaccid-myelitis/

  AFM is a condition that affects the spinal cord or parts of the brainstem, mostly in children. It can cause sudden weakness and paralysis, ranging from weakness of the facial muscles, to limb weakness, to weakened breathing. It often starts during or just after a mild respiratory illness or fever. People describe AFM as ‘polio-like’ because, like polio, AFM affects the motor nerves in the spinal cord. […] The early signs of AFM include inability to move one of the limbs or the face, or pain in the affected limb, neck or back. If your child has any of these symptoms, it makes sense to have them checked out by their primary care physician. Although it’s a scary illness for parents to think about, it’s important to remember that it’s very rare. […] Because we’re still learning more about AFM, the only prevention tool we know of right now is good infection control. This means taking the same precautions you would to avoid colds and the flu, such as coughing into your elbow, washing your hands often and avoiding close contact with those who are sick. The same precautions, including social distancing, that are being taken to prevent COVID-19 are likely to help prevent AFM.

• #5 Acute flaccid myelitis | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/acute-flaccid-myelitis/

  Acute flaccid myelitis (AFM) is a rare condition that tends to occur in outbreaks every few years. […] It often follows a mild viral infection affecting the upper airway or stomach. […] The spinal cord is part of the central nervous system and plays an important role in how messages travel to and from the brain. […] In AFM, the grey matter in the spinal cord is damaged which interferes with message transmission to and from the brain, leading to sudden weakness. […] It is clear that the grey matter within the spinal cord is damaged in AFM. This particularly affects the area containing motor neurons which are needed for movement. […] Acute flaccid myelitis (AFM) is a very rare condition mainly affecting children aged under 18 years. […] Initially, the main symptom of AFM is sudden asymmetrical weakness affecting the arms or leg.

• #6 Acute Flaccid Myelitis (AFM) | Living With Paralysis

  https://www.christopherreeve.org/todays-care/living-with-paralysis/health/causes-of-paralysis/afm/

  Acute flaccid myelitis (AFM) is a sudden onset of paralysis in the spinal cord. AFM affects LMNs, with the result of flaccid (limp) muscle weakness, muscular atrophy (wasting), fasciculation (single nerve twitches), and hyporeflexia (poorly responding reflexes). There is no formal treatment protocol for AFM. Instead, treatment is based on individual symptoms of each case. Rehabilitation will include physical and occupational therapy to provide input to those nerves and muscles that are underpowered. Registered nurses will carry out the therapists recommendations throughout the day. […] Recovery from AFM is a process. There is no curative treatment found to date. A physician that specializes in physical medicine and rehabilitation (called a physiatrist), a neurologist, a pediatrician or a combination of specialists will coordinate medical needs. […] Depending on the individual situation, there are treatments that can help individuals breathe. Non-Invasive Ventilation (NIV) is used for acute respiratory dysfunction (ARD) or acute respiratory failure (ARF) but can also be used for long term breathing.

• #7 Acute Flaccid Myelitis (AFM) Diagnosis & Treatment

  https://www.gillettechildrens.org/conditions-care/acute-flaccid-myelitis-afm

  Acute flaccid myelitis (AFM) is a rare but serious condition that affects the nervous system. AFM happens when swelling in the spinal cord causes the muscles and reflexes in the body to become weak. […] Most patients with AFM have a respiratory illness or fever before their limbs are affected. […] Most children will have a sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Some children, in addition to arm or leg weakness, will have: […] The most severe symptom of AFM is respiratory failure that can happen when the muscles involved with breathing become weak. This can require urgent ventilator support (breathing machine). […] Currently, there is no specific treatment or vaccine for AFM, but a doctor who specializes in treating brain and spinal cord illnesses (neurologist) might recommend certain treatments on a case-by-case basis. For example, neurologists might recommend physical or occupational therapy to help with arm or leg weakness caused by AFM. Early physical and rehabilitative therapy for children who have AFM might be beneficial in preventing muscle loss, joint rigidity and might improve functional outcomes.

• #8 Acute Flaccid Myelitis (AFM) – HAN

  https://www.chicagohan.org/diseases-and-conditions/afm

  Acute flaccid myelitis (AFM) is an illness characterized by acute onset of flaccid limb weakness and magnetic resonance imaging (MRI) showing lesions in the gray matter of the spinal cord. […] Most AFM cases have arm and/or leg weakness coupled with loss of muscle tone and reflexes. Additionally, some cases have facial/eyelid drooping, difficulty swallowing, slurred speech, difficulty moving their eyes, and/or pain in their arms and legs. […] AFM is an uncommon but serious neurologic condition. Sudden onset of arm or leg weakness, loss of muscle tone, and loss of reflexes are the most common symptoms. Most people will have sudden onset of arm or leg weakness, some people will have, difficulty moving the eyes or dropping eyelids, facial droop or weakness, difficulty swallowing, pain in arms or legs, pain in neck or back.

• #9 Acute Flaccid Myelitis (AFM) | Florida Department of Health

  https://www.floridahealth.gov/diseases-and-conditions/afm/index.html

  Acute flaccid myelitis (AFM) is an uncommon but serious neurologic condition that may cause limb weakness and poor muscle response. Individuals of any age may get AFM, but it is most common in young children (more than 90%). AFM can be caused by viruses, including enteroviruses, and most patients have respiratory symptoms consistent with a viral infection within one week prior to limb weakness. […] Most patients with AFM will have sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Some patients may also experience: […] Uncommonly, patients with AFM may experience numbness or tingling in arms or legs. The most severe symptoms of AFM include difficulty breathing due to muscle weakness and serious neurologic complications such as body temperature changes and blood pressure instability.

• #10 Acute Flaccid Myelitis in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/acute-flaccid-myelitis-in-children.html

  AFM is a rare condition that affects the nervous system. It damages the spinal cord, leading to muscle weakness and reflex problems. Its symptoms start suddenly and may cause paralysis in the arms or legs. In some cases, AFM can be life-threatening if it affects the muscles that control breathing or swallowing. […] The symptoms of AFM can vary from child to child. They can range from mild to severe. They often start suddenly within a week or so after recovering from a flu or cold-like illness. Symptoms of AFM may include: Sudden weakness, often in an arm or leg; Poor muscle tone and reflexes; Pain in the arms, legs, neck, or back; Weakness in the face that can cause problems swallowing, breathing, or speaking; Trouble moving the eyes or droopy eyelids; Problems controlling the bladder or bowel.

• #11 Acute Flaccid Myelitis (AFM) | Rady Children’s Hospital

  https://www.rchsd.org/health-article/acute-flaccid-myelitis-afm

  Acute flaccid myelitis (AFM) is a rare condition that affects the spinal cord. It comes on suddenly and makes muscles weak and floppy. It looks similar to polio, so it is sometimes called a polio-like illness. It is most commonly seen in children around age 6. […] A child with AFM usually has sudden weakness in the arms and legs. Other signs of acute flaccid myelitis include: arm, leg, or neck pain, drooping eyelids, trouble moving the eyes, drooping mouth, slurred speech, trouble swallowing, trouble breathing. […] If you or your child have any of these symptoms, get medical care right away. […] It isnt clear why some children get AFM after a viral infection and others dont. So its best if everyone tries to avoid spreading germs by: washing hands well and often, keeping vaccinations up to date, staying away from people who are sick, keeping household surfaces clean and disinfected, keeping sick children home from school and daycare.

• #12 Acute Flaccid Myelitis — LittleArms.org

  https://www.littlearms.org/acute-flaccid-myelitis

  Acute Flaccid Myelitis, or Acute Flaccid Paralysis is a polio-like condition where a child loses the ability to move their muscles after experiencing cold or flu-like symptoms. […] Approximately 1 in 4 children will lose the ability to breathe for themselves, requiring a ventilator for at least a few days to months. […] So far, the only treatment for AFM that has shown some efficacy is nerve transfer. Nerve transfers involve taking redundant parts of a child’s nerves and transferring them to nerves that are not working. […] In order to be a candidate for nerve transfers, children must have some redundancy in their nerve function. These redundant nerves are referred to as donors. Children must also have discrete muscle functions that need to be restored that are controlled by a single nerve. These nerves that have lost their function are called recipients. […] Children with AFM can lose the ability to breathe when their phrenic nerve is injured. Some children, however, may be able to have their respiratory function restored if just one of the intercostal nerves is functioning.

• #13 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Acute-Flaccid-Myelitis.aspx

  In 2012, CDPH began receiving reports of patients with an unusual condition called acute flaccid myelitis (AFM). Since then, there have been statewide and nationwide spikes in AFM cases noted in the summer and fall months of 2014, 2016 and 2018. […] AFM patients are primarily children, although cases have also been reported in adults. Symptoms typically include a preceding febrile respiratory illness followed by sudden onset of limb weakness and loss of muscle tone and reflexes. In addition to limb weakness, some patients have cranial nerve involvement and present with facial droop/weakness, difficulty moving the eyes, drooping eyelids, or difficulty with swallowing or slurred speech. […] If you or your child develops any of these symptoms, you should seek medical care right away. […] Although a viral cause is suspected, it is still unknown why some people develop AFM. There is no specific action to take to prevent AFM. However, it is always important to practice disease prevention steps, such as washing hands frequently, avoiding close contact with people who are sick, covering coughs and sneezes, and cleaning frequently touched surfaces.

• #14 Acute Flaccid Myelitis (AFM) | Florida Department of Health

  https://www.floridahealth.gov/diseases-and-conditions/afm/index.html

  Symptoms can progress rapidly and be life threatening. […] If you see potential symptoms of AFM in your child, contact your health care provider right away. […] Since AFM can develop after a viral infection, The Florida Department of Health recommends parents and children take basic steps to avoid becoming infected with or spreading a virus including:

• #15 Acute Flaccid Myelitis: Diagnosis and Management Basics, Ongoing Questions | Children’s Hospital of Philadelphia

  https://www.chop.edu/news/acute-flaccid-myelitis-diagnosis-and-management-basics-ongoing-questions

  A high index of suspicion is necessary to make the diagnosis of AFM, given that so many more benign conditions present with unilateral upper extremity weakness. […] AFM is associated with a risk of progression to respiratory decompensation and the need for ventilatory support, so these patients must be carefully monitored in the hospital. Management of AFM is primarily supportive, and in the absence of controlled trials the optimal medical management remains unclear. […] Early initiation of therapies, including inpatient rehabilitation, is essential. Improvement with continued physical and occupational therapy may continue, even years from diagnosis. Nerve transfer surgery may be an option for some patients with persistent weakness. […] In summary, AFM is an emerging condition with significant associated morbidity. Close monitoring of affected patients is warranted.

• #16 Acute flaccid myelitis – Wikipedia

  https://en.wikipedia.org/wiki/Acute_flaccid_myelitis

  Acute flaccid myelitis (AFM) is a serious condition of the spinal cord. Symptoms include rapid onset of arm or leg weakness and decreased reflexes. Treatment involves supportive care. Physical therapy may be recommended. Occasionally, mechanical ventilation is required to support breathing. Outcomes are variable. […] Diagnosis of AFM requires acute onset limb paralysis and at least one gray-matter spinal-cord lesion. CSF should show pleocytosis. […] Treatment involves supportive care. Physical therapy may be recommended. Occasionally mechanical ventilation is required to support breathing.

• #17 Acute flaccid myelitis: Nursing implications and public health. – Document – Gale OneFile: Health and Medicine

  https://go.gale.com/ps/i.do?id=GALE%7CA616904284&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=19305583&p=HRCA&sw=w

  ACUTE FLACCID MYELITIS (AFM) is a rare condition that has caught the attention of health professionals around the world. […] The following review will guide you in identifying and managing AFM and public health reporting steps. […] AFM can be difficult to diagnose because signs and symptoms resemble other diseases such as enteroviruses, West Nile virus, cytomegalovirus, Guillain-Barre syndrome, and adenoviruses. […] Clinicians use clinical criteria and diagnostic testing to classify cases as confirmed or probable.

• #18 Department of Public Health – Acute Communicable Disease Control

  http://publichealth.lacounty.gov/acd/Diseases/AFM.htm

  Acute flaccid myelitis (AFM) is an illness characterized by a sudden onset of acute flaccid limb weakness without a known cause and magnetic resonance imaging (MRI) showing lesions in the gray matter of the spinal cord. Most cases are in children. […] Clinical diagnosis is made by reviewing neurological symptoms, examining brain and spinal MRIs, Cerebrospinal Fluid (CSF) testing and testing of nerve conduction and response.

• #19 Acute flaccid myelitis | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/acute-flaccid-myelitis/

  As well as weakness, the limb becomes floppy (flaccid) and the normal spinal reflexes decrease or disappear. […] Muscle weakness can also affect the face, causing the eyelid to droop or one side of the face to weaken or can cause difficulty breathing or swallowing or problems with bladder and bowel. […] In around 20 per cent of children, this muscle weakness affects the diaphragm, the curved muscle in the chest that rises and falls when breathing. […] It is important to take your child to the doctor if they develop any sudden weakness. Identifying AFM quickly and starting treatment can reduce the risk of complications from serious problems such as when breathing is affected. […] A lumbar puncture is needed to collect a sample of cerebrospinal fluid (CSF) from around the spinal cord this is then examined in our laboratory.

• #20 Acute Flaccid Myelitis (AFM)

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/afm.html

  Reporting of these cases will help public health officials monitor for increases in this illness and better understand potential causes, risk factors, and preventive measures or therapies. […] Clinicians suspecting AFM in patients meeting the probable or confirmed case definition (irrespective of laboratory testing results) are asked to report these cases to the local health department governing the jurisdiction where the patient lives. […] Early specimen collection has the best chance to yield a diagnosis of AFM.

• #21 Acute Flaccid Myelitis (AFM)

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/diseases/afm.html

  Acute flaccid myelitis (AFM) is a rare but serious condition that affects the nervous system, specifically the spinal cord, causing the muscles and reflexes in the body to work abnormally. […] There is no specific treatment for AFM, but a neurologist may recommend certain interventions on a case-by-case basis. […] The Illinois Department of Public Health (IDPH) is re-emphasizing the importance of continued vigilance in identifying cases of AFM among all age groups, irrespective of enterovirus status. […] Reporting of these cases will help public health officials monitor for increases in this illness and better understand potential causes, risk factors, and preventive measures or therapies. […] Clinicians suspecting AFM in patients meeting the probable or confirmed case definition (irrespective of laboratory testing results) are asked to report these cases to the local health department governing the jurisdiction where the patient lives, or to the Illinois Department of Public Health Communicable Disease Control Section at 217-782-2016. […] Clinicians should collect specimens from patients suspected of having AFM as early as possible in the course of illness, preferably on the day of onset of limb weakness.

• #22 Acute Flaccid Myelitis (AFM) – HAN

  https://www.chicagohan.org/diseases-and-conditions/afm

  Clinicians should continue to be vigilant and report all patients under investigation that meet the clinical criteria for acute flaccid myelitis (i.e., sudden onset of flaccid limb weakness) to the Chicago Department of Public Health (CDPH) regardless of any laboratory results or MRI findings. […] Clinicians should continue to be vigilant and send information to Chicago Department of Public Health (CDPH) for all patients under investigation (PUI) with sudden onset of neurologic illness associated with limb weakness that meet the case definition for Acute Flaccid Myelitis. Clinicians should send information for PUIs who meet the case definition regardless of any laboratory results.

• #23 Clinical Guidance for the Acute Medical Treatment of AFM | Acute Flaccid Myelitis (AFM) | CDC

  https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinical-guidance/index.html

  This guidance is intended to apply to acute flaccid myelitis (AFM) and the initial pharmacologic treatments that have been used in patients with AFM. […] Clinicians should immediately consult with their local neurologists and/or infectious disease specialists for treatment and medical management decisions for any suspected AFM patient. […] Currently, there are no FDA-approved drugs or biologics for treating or preventing AFM. […] Clinicians should expedite neurology and infectious disease consultations to discuss treatment and management considerations. […] There is no indication that any specific targeted treatment should be either preferred or avoided in the acute medical treatment of AFM. […] There is currently no targeted treatment with enough evidence to endorse or discourage use for the treatment or management of AFM.

• #24 Acute Flaccid Myelitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK606127/

  The treatment of AFM is mainly supportive, including cardiovascular support, autonomic and bowel disturbances management, pain control, thromboembolism, and pressure ulcer prophylaxis. […] Patients with AFM require a multidisciplinary approach, necessitating consultations with various specialists to optimize care and improve outcomes. […] Nurses play a critical role in monitoring patient status, providing supportive care, and educating families about the disease and care procedures. […] By focusing on patient-centered care, enhancing communication, and continuously improving care processes, healthcare professionals can significantly improve outcomes and safety for patients with AFM.

• #25 Your Child’s Care | Acute Flaccid Myelitis (AFM) | CDC

  https://www.cdc.gov/acute-flaccid-myelitis/helping-children/healthcare.html

  An acute flaccid myelitis (AFM) diagnosis is serious. […] If your clinician suspects your child has AFM, they should hospitalize your child immediately. […] You should ensure that you seek medical care right away if you see symptoms of AFM in your child. […] If your child has AFM, there are some rehabilitation options that may help improve their outcomes. […] Physical rehabilitation might also improve long-term outcomes if your clinician implements it early in your child’s illness onset. […] Some patients have also received nerve transfer surgery (used to repair nerve injuries) in hopes of improving long-term outcomes. […] Talk to your clinician about these options for your child’s long-term care. […] Many different types of clinicians may be involved in your child’s care. […] Each clinician has an important role in helping your child get better. […] Educate others involved in your child’s life about AFM, such as school staff, other family members, and your child’s peers. […] Spending time with others is an important part of wellbeing and recovery.

• #26 Clinical Guidance for the Acute Medical Treatment of AFM | Acute Flaccid Myelitis (AFM) | CDC

  https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinical-guidance/index.html

  Acute treatments that have been used frequently in patients with AFM include intravenous immunoglobulin, corticosteroids, and/or therapeutic plasma exchange. […] There is no indication that IVIG should be either preferred or avoided in the treatment of AFM. […] There is no clear human evidence for efficacy of IVIG in the treatment of AFM; evidence for efficacy is based on early treatment in animal models infected with enterovirus (EV) D68 and it has not been given in a systematic manner to AFM patients to allow for measurements of efficacy. […] There is no indication that corticosteroids should be either preferred or avoided in the treatment of AFM. […] There is no clear human evidence for efficacy of corticosteroids in the treatment of AFM, and there is some evidence in a mouse model with EV-D68 that corticosteroids may be harmful.

• #27 Acute flaccid myelitis (AFM) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-flaccid-myelitis/diagnosis-treatment/drc-20493060

  Currently, there is no specific treatment for acute flaccid myelitis. Treatment is aimed at managing symptoms. […] A doctor who specializes in treating brain and spinal cord illnesses (neurologist) might recommend physical or occupational therapy to help with arm or leg weakness. If physical therapy is started during the initial phase of the illness, it might improve long-term recovery. […] The doctor might also recommend treatment with immunoglobulin that contains healthy antibodies from healthy donors, drugs that lower inflammation in the body (corticosteroids) or antiviral drugs. Or the doctor might recommend a treatment that removes and replaces blood plasma (plasma exchange). However, it’s not clear whether these treatments have any benefits. […] Sometimes nerve and muscle transfer surgeries are done to improve limb function.

• #28 Clinical Guidance for the Acute Medical Treatment of AFM | Acute Flaccid Myelitis (AFM) | CDC

  https://www.cdc.gov/acute-flaccid-myelitis/hcp/clinical-guidance/index.html

  There is no indication that therapeutic plasma exchange should be either preferred or avoided in the treatment of AFM. […] There is no clear human evidence for efficacy of TPE in the treatment of AFM, and it has not been given in a systematic manner to AFM patients to allow for measurements of efficacy. […] There is no indication that fluoxetine should be used for the treatment of AFM. […] There is no indication that currently available antivirals should be used for the treatment of AFM. […] There is no indication that interferon should be used for the treatment of AFM. […] There is no indication that the use of other immunosuppressive agents or biologic modifiers should be used for the treatment of AFM.

• #29

  https://www.gov.uk/government/publications/acute-flaccid-paralysis-clinical-management-guidance/clinical-management-of-acute-flaccid-paralysis-or-acute-flaccid-myelitis

  Supportive care is the mainstay of acute treatment of a case of AFP or AFM. The priority for the immediate management is to ensure that the patients airway is secure. High dependency or intensive care unit admission should be considered according to neurological progression or deficits present; mechanical ventilation is required in up to 20% of patients (2, 3). […] Early physiotherapy and occupational therapy to maintain supple passive range of movement in the affected limbs during the period of paralysis is key to treatment. Evidence suggests that children with AFM and other forms of myelitis can continue to regain strength and function in affected limbs for months to years following presentation (2). […] Nerve transfers are known to be beneficial in restoring innervation and function to denervated muscles. Nerve transfer involves the re-routing of parts of functioning nerves from a functioning muscle to renervate muscles that are considered more useful (2). […] The identification of patients that will not spontaneously recover is the challenge, and local protocols in the USA are suggesting that any patient who has muscle which has not renervated by 3 (and certainly by 6 months) should be considered for nerve transfer surgery (18).

• #30 Acute Flaccid Myelitis (AFM) | Kennedy Krieger Institute

  https://www.kennedykrieger.org/patient-care/conditions/acute-flaccid-myelitis-afm

  Acute flaccid myelitis (AFM) is a rare, polio-like condition that affects the body’s nervous system, specifically the spinal cord. […] The most important treatment for children diagnosed with AFM is early, intensive rehabilitation. […] At Kennedy Krieger Institute, whether the child is treated on the inpatient unit or in the outpatient program, his/her care is provided by a team of experts in the treatment of spinal cord disease and related paralysis. […] Rehabilitation for children with AFM requires persistence and evolving knowledge. […] Every child leaves Kennedy Krieger Institute with an individualized home and community rehabilitation program. […] Rehabilitation for children with AFM may be a long process and the professionals at Kennedy Krieger Institute are there with you every step of the way. […] Researchers at Kennedy Krieger Institute Find Rehabilitation is Essential in Restoring and Improving Function in Children with Acute Flaccid Myelitis (AFM).

• #31 Acute flaccid myelitis (AFM) in children – Children’s Health Neurology

  https://www.childrens.com/specialties-services/conditions/acute-flaccid-myelitis

  We will do early rehabilitation that is aggressive and lasts as long as your child needs. […] Physical therapy (PT), to help your child improve their muscle coordination and strength. […] Occupational therapist (OT) also may work with your child on daily activities, such as eating, bathing or putting on their clothes. […] Finally, we are one of the few centers in the county where a child can get a nerve transfer procedure, in which a healthy nerve from another part of the body can be moved into a paralyzed hand so that it can move again. This procedure can be useful for select patients.

• #32 Acute Flaccid Myelitis (AFM) | Long-Term Care | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/acute-flaccid-myelitis/long-term-care/

  After the acute phase, rehabilitative care to improve functional skills and prevent secondary complications of immobility involves both psychological and physical accommodations. […] It is important to begin occupational and physical therapies early during the course of recovery to prevent the inactivity-related problems of skin breakdown and soft tissue contractures that lead to a decreased range of motion. […] The long-term management of AFM requires attention to a number of issues. […] A subset of patients with AFM may experience marked respiratory and diaphragmatic dysfunction. […] In those with AFM where only the grey matter is impacted, muscles will be weak and lack muscle tone, so rehabilitation strategies should be adapted to this low level of muscle tone. […] Most with AFM will experience musculoskeletal complications associated with muscle weakness and atrophy.

• #33 Acute Flaccid Myelitis (AFM) | Long-Term Care | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/acute-flaccid-myelitis/long-term-care/

  While sensation is frequently intact in AFM, impaired mobility may place individuals at risk for skin breakdown due to a lack of or less movement. […] Changes in sensation may occur in those with AFM and can manifest as lack of sensation, or numbness, as well as painful sensations called neuropathic pain. […] Bladder dysfunction may not occur in all individuals with AFM. […] Another major area of concern is effective management of bowel function. […] Individuals and caregivers of children with AFM should be aware and educated about the possible effect of AFM on mood regulation. […] Autonomic dysreflexia can occur when a spinal cord is damaged above the T6 level. […] Sexual dysfunction involves similar innervation and analogous syndromes as those found in bladder dysfunction. […] Some individuals may benefit from nerve or tendon transfer procedures to improve function.

• #34 Acute Flaccid Myelitis (AFM) | Long-Term Care | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/acute-flaccid-myelitis/long-term-care/

  It is important to begin occupational and physical therapies early during the course of recovery to prevent the inactivity-related problems of skin breakdown and soft tissue contractures that lead to a decreased range of motion. […] Individuals with AFM may find ordinary tasks such as dressing, bathing, grooming, and eating very difficult.

• #35 Acute Flaccid Myelitis (AFM) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/acute-flaccid-myelitis

  Acute flaccid myelitis (AFM) is a condition that affects the nervous system, usually in young children. AFM affects the motor neurons in the spinal cord or brainstem and can progress rapidly. The most common symptoms are the sudden onset of weakness in the arms and legs. In rare cases, the loss of muscle tone and reflexes can lead to complete paralysis in one or more limbs. If you suspect your child has AFM, contact your doctor. […] If your child develops any AFM symptoms, it’s important to contact your doctor right away. AFM can have serious long-term health effects and requires immediate medical attention. […] There is no specific treatment at this time for acute flaccid myelitis. Your child’s doctor may recommend intravenous immunoglobulin (IVIG) or other medications. Your doctor may also recommend surgery to replace the function of the damaged nerves. In nerve transfer surgery, an orthopedic surgeon transfers healthy nerves to take over the function of the nerves damaged by the virus. In tendon transfer surgery, nearby unaffected muscles are moved to take over the muscles that are weak due to the virus.

• #36 Acute flaccid myelitis (AFM) in children – Children’s Health Neurology

  https://www.childrens.com/specialties-services/conditions/acute-flaccid-myelitis

  At Childrens Health, we have the expertise to treat this rare and serious disorder. We offer comprehensive care for acute flaccid myelitis, so that your child can work with all the specialists they need. […] Acute flaccid myelitis (AFM) in children is a rare, serious neurological disease. It affects a part of the spinal cord called gray matter and causes muscles to become weak. […] AFM causes weakness and paralysis in children by damaging the lower motor neurons. […] In treating AFM at Childrens Health, we first try to limit damage to the spinal cord. We may use high doses of steroids or plasma exchange therapy (PLEX), which replaces the plasma in the blood with other fluids. […] We will work with your child to manage their symptoms, which can mean helping manage nerve pain, problems with urinary or bowel function, or other complications.

• #37 Acute Flaccid Myelitis (AFM) | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/acute-flaccid-myelitis-afm/

  Our neurologists develop a customized treatment plan based on each patients specific symptoms and overall health. Treatment options include: Anti-inflammatory therapies, Pain management, Physical therapy, Occupational therapy, Oxygen therapy, Speech-language therapy, Nerve transfer surgery. […] Some therapies can help relieve symptoms and support recovery.

• #38 Acute Flaccid Myelitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/161699

  AFM clinically presents with acute asymmetric lower motor neuron paralysis with spared sensation. […] Rehabilitation, physical therapy, and psychological support play an indispensable role in maximizing recovery for patients with AFM. […] The treatment of AFM is mainly supportive, including cardiovascular support, autonomic and bowel disturbances management, pain control, thromboembolism, and pressure ulcer prophylaxis. […] Intensive physical and occupational therapy is essential to maximize functional recovery and minimize long-term disability. […] Patients with AFM require a multidisciplinary approach, necessitating consultations with various specialists to optimize care and improve outcomes. […] Nurses play a critical role in monitoring patient status, providing supportive care, and educating families about the disease and care procedures. […] Effective communication among team members is critical in the patient’s pathway from diagnosis through treatment and rehabilitation.

• #39 Acute Flaccid Myelitis

  https://www.aap.org/en/patient-care/acute-flaccid-myelitis/?srsltid=AfmBOor0_ngnvNwgdijmhHrZ1HEWWJuL3zJ7VBjx_8iSEj5XynSCI8LE

  Acute flaccid myelitis (AFM) is a rare but serious neurological illness that causes muscle weakness, sometimes leading to paralysis. […] Early detection and medical support are critical to improve long-term health outcomes of children with AFM. Delays in recognition can put children at risk. Pediatricians and pediatric health care providers who can identify AFM and promptly hospitalize patients are best positioned to provide optimal medical care.

• #40 Acute flaccid myelitis

  https://www.myamericannurse.com/acute-flaccid-myelitis/

  Acute flaccid myelitis (AFM) is a perplexing condition which, to date, has no concrete effective treatment. […] The Centers for Disease Control and Prevention recommends standard + contact + droplet infection prevention guidelines. […] Neurology and infectious disease consultations are recommended for all patients who present with signs and symptoms of AFM.

• #41

  https://learn.nasn.org/courses/49110

  Program Overview Acute flaccid myelitis (AFM) is a rare but serious polio-like illness characterized by rapid-onset flaccid weakness and paralysis. AFM has been gaining global attention since its first large outbreak in 2014. Since then, AFM has peaked every 2 years, late summer to fall, with researchers anticipating the next wave in 2020. Without a clear understanding of what causes or triggers AFM, healthcare providers are struggling to recommend specific action to prevent AFM and to establish treatment guidelines. School health plays an important role in the early awareness and advocacy of AFM. School nurses should be vigilant for possible cases by identifying AFM symptoms and advocating to rule out the diagnosis. Gathering a history of any recent respiratory or GI illness, regardless of fever, will be helpful when referring for further assessment. Most children experienced a respiratory illness or fever consistent with a viral infection before developing arm or leg weakness. This session will provide the education and resources to enable the school community to increase the identification of early symptoms. This session will also prepare the school nurse to lead the transition of a student diagnosed with AFM back into the school setting. Perspectives from parents as well as multidisciplinary team members will offer insight into the multiple phases of AFM. While the outcome for children diagnosed with AFM is uncertain, a multidisciplinary team that includes the school nurse is essential to the support the child and family will require.

• #42

  https://learn.nasn.org/courses/49110

  Learning Outcomes As a result of participating in this educational program, learners will be able to: Define acute flaccid myelitis (AFM) and summarize current CDC updates. Utilize resources to educate the school community about global emergence of AFM as a public health epidemic. Collaborate with pediatric rehabilitation facilities to advance understanding of multidisciplinary treatment and medical management of a student re-entering school. Apply the Framework of the 21st Century School Nursing for Coordinating Care and Leadership to support students with AFM. […] Intended Audience This continuing education program is a practice, skill, and knowledge NCPD program developed to meet the educational needs of registered nurses who are interested in child, adolescent health, community/public health, and school nursing.

• #43 Acute Flaccid Myelitis (AFM) | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/acute-flaccid-myelitis-afm/

  At UT Southwestern Medical Center, our specialists in neurology, infectious diseases, physical medicine and rehabilitation, and nerve transplant surgery have expertise in accurately diagnosing and effectively treating acute flaccid myelitis (AFM). […] We provide the latest treatments, such as acute therapy and advanced nerve transfer surgery, to improve function and help patients get back to the activities they enjoy. […] Our experienced doctors and surgeons specialize in treating complex conditions affecting the brain and spinal cord, such as AFM. […] At UT Southwestern, we take a team approach, working closely with other specialties here and at the Childrens Health Dallas Neurosciences Center to provide effective, compassionate care. […] Our team includes providers from neurology, neurosurgery, infectious disease, orthopaedics, pulmonology, pain management, physical therapy, and occupational therapy.

• #44 Acute Flaccid Myelitis (AFM) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/acute-flaccid-myelitis

  The Neuroimmunology Center at Boston Children’s Hospital is dedicated to the comprehensive care of children and adolescents who are affected by autoimmune disorders of the brain and spinal cord (neuro-immune disorders). Our program works in collaboration with physiatry, endocrinology, psychiatry, and orthopedics. […] Boston Children’s Orthopedics and Sports Medicine Department blends cutting-edge treatments and surgical approaches with prompt, family-centered care. Our specialists in the upper and lower extremities have extensive experience performing nerve transfers, muscle transfers, and other delicate procedures that maintain and restore function so children can lead full, independent lives.

• #45 Acute Flaccid Myelitis (AFM)

  https://www.health.ny.gov/diseases/conditions/acute_flaccid_myelitis/

  Acute flaccid myelitis is a rare but serious condition that affects the nervous system. It was first discovered in 2014. Acute Flaccid Myelitis mostly occurs in young children and targets the gray matter in the spinal cord, making muscles and reflexes in one or more limbs weak. This weakness happens quickly, often affects one side of the body more than the other and can lead to paralysis. […] Patients with Acute Flaccid Myelitis are cared for in the hospital where healthcare providers monitor their condition. Treatment focuses on reducing spinal cord inflammation, managing symptoms, and preventing complications. […] Some patients see improvements in muscle function over time. A few fully recover, often around 4 months after symptoms begin. However, some patients do not improve and remain weak or paralyzed.

• #46 Acute flaccid myelitis (AFM)

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20491145

  Acute flaccid myelitis (AFM) is a rare but serious condition that affects the spinal cord. […] If you or your child develops symptoms of acute flaccid myelitis, seek immediate medical care. Symptoms can progress rapidly. Hospitalization is needed and sometimes a ventilator is required for breathing support. […] Acute flaccid myelitis mainly affects young children. […] Muscle weakness caused by acute flaccid myelitis can continue for months to years. […] Currently, there is no specific treatment for acute flaccid myelitis. Treatment is aimed at managing symptoms. […] A doctor who specializes in treating brain and spinal cord illnesses (neurologist) might recommend physical or occupational therapy to help with arm or leg weakness. If physical therapy is started during the initial phase of the illness, it might improve long-term recovery. […] Sometimes nerve and muscle transfer surgeries are done to improve limb function.

• #47 Acute Flaccid Myelitis (AFM) | Washington State Department of Health

  https://doh.wa.gov/public-health-provider-resources/notifiable-conditions/afm

  AFM is treated through supportive care, which is recommended by teams of expert health care providers on a case-by-case basis. […] The long-term effects of AFM are different for each person. Some people diagnosed with AFM recover quickly and completely. Others have continued weakness and require ongoing, high-level care.

• #48 A Complete Guide to Acute Flaccid Myelitis in Children – Avisena Women’s & Children’s Specialist Hospital

  https://womenandchildren.avisena.com.my/health-articles/acute-flaccid-myelitis-recognizing-the-symptoms-and-seeking-early-treatment/

  Recovery from AFM can be a long and challenging process. […] Psychological support, including counselling and support groups, can help families cope with the stresses associated with the illness and recovery process. […] Early diagnosis of AFM is essential for better outcomes. […] Immediate medical attention is critical to initiating treatment and improving the chances of recovery. […] Recognising the acute flaccid myelitis symptoms early, understanding the acute flaccid myelitis causes, and seeking prompt acute flaccid myelitis treatment can make a significant difference in the outcome.

• #49 Acute flaccid myelitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/acute-flaccid-myelitis

  Acute flaccid myelitis is a rare condition that affects the nervous system. Inflammation of the gray matter in the spinal cord leads to muscle weakness and paralysis. […] Acute flaccid myelitis (AFM) is usually caused by infection with a virus. While AFM is rare, there has been a slight increase in cases of AFM since 2014. Most new cases have occurred in children or young adults. […] There is no specific treatment for AFM. You may be referred to a doctor specializing in disorders of the nerves and nervous system (neurologist). The doctor will likely treat your symptoms. […] You may need physical therapy to help restore muscle function. […] Complications of AFM include: Muscle weakness and paralysis, Loss of limb function. […] Contact your provider right away if you or your child have: Sudden weakness in the arms or legs or difficulty moving the head or face, Any other symptom of AFM. […] There is no known way to prevent AFM. Having a polio vaccine may help reduce the risk of AFM related to the poliovirus.

• #50 Acute flaccid myelitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007743.htm

  Acute flaccid myelitis is a rare condition that affects the nervous system. Inflammation of the gray matter in the spinal cord leads to muscle weakness and paralysis. […] Acute flaccid myelitis (AFM) is usually caused by infection with a virus. […] AFM usually occurs after a cold, fever, or gastrointestinal illness. […] A fever or a respiratory illness is often present before weakness and other symptoms begin. […] AFM symptoms often start with sudden muscle weakness and loss of reflexes in an arm or leg. […] There is no specific treatment for AFM. You may be referred to a doctor specializing in disorders of the nerves and nervous system (neurologist). The doctor will likely treat your symptoms. […] You may need physical therapy to help restore muscle function. […] Complications of AFM include muscle weakness and paralysis. […] Contact your provider right away if you or your child have sudden weakness in the arms or legs or difficulty moving the head or face. […] There is no known way to prevent AFM. Having a polio vaccine may help reduce the risk of AFM related to the poliovirus.

• #51 Acute Flaccid Myelitis | Orange County California – Health Care Agency

  https://www.ochealthinfo.com/page/acute-flaccid-myelitis

  Acute flaccid myelitis (AFM) is a rare but serious condition that affects the nervous system, specifically the spinal cord, and causes sudden onset of weakness in limbs (one or more arms or legs) and loss of muscle tone. Other symptoms may include facial weakness, droopy eyelids, difficulty moving eyes, swallowing or speaking. […] Treatment is supportive; no specific treatment for AFM is available. […] General disease prevention steps are recommended: Keep up to date on vaccinations, including polio vaccine to avoid polio-associated AFM. […] Suspect cases should be reported to Orange County Epidemiology at 714-834-8180 or fax records to 714-560-4050. Specimens on suspect AFM cases that meet criteria may be submitted for testing for specific infectious etiologies through Orange County Public Health.

• #52 ACUTE FLACCID MYELITIS: A POLIO-LIKE ILLNESS PARENTS SHOULD KNOW ABOUT | Mya Care

  https://myacare.com/blog/acute-flaccid-myelitis-a-poliolike-illness-parents-should-know

  Acute Flaccid Myelitis (AFM) is a rare neurological condition that affects the spinal cord, causing sudden muscle weakness or paralysis. […] Treatment options for AFM are limited, and early detection can greatly improve outcomes. Supportive care is the mainstay treatment for the initial phase, while nerve transfer surgery may be an option for treating long-term muscle weakness. […] Parents need to seek medical attention urgently if their child experiences any of these symptoms, especially if they occur suddenly. […] It is important for parents to be aware of this condition and its symptoms, as early detection and treatment can greatly improve outcomes. […] By staying informed and taking preventative measures, parents can help reduce their child’s risk of developing AFM.

• #53 Acute Flaccid Myelitis in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/acute-flaccid-myelitis-in-children.html

  The symptoms of AFM can get worse quickly, so your child will get treatment in a hospital. While there, your child will be watched for any serious symptoms like trouble breathing. […] There is no specific treatment or medicine for AFM. Your child may get supportive care. This may include medicine for pain or other treatments to ease certain symptoms. If your child has trouble breathing, they may be given oxygen or put on a ventilator to help them breathe. […] Physical and occupational therapy is key in helping your child manage these problems. If your child has trouble moving, they may also benefit from using orthotic or assistive devices. Work closely with your child’s care team, including a neurologist and physical therapist, to address your child’s needs. […] AFM can cause lasting muscle weakness. Physical and occupational therapy can help.

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