Materiały źródłowe

• #1 Acute flaccid myelitis (AFM)

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

  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.

• #2 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. […] Currently, there are no FDA-approved drugs or biologics for treating or preventing AFM. […] 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. […] 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.

• #3 Acute flaccid myelitis: cause, diagnosis, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7909727/

  Acute management of AFM is largely supportive because there is an absence of therapeutic agents proven to alter outcomes. A substantial proportion of patients with AFM will become critically ill during the acute illness, requiring intubation due to respiratory failure or severe bulbar weakness. Appropriate rehabilitation can improve functional status and quality of life after AFM. Additionally, surgical approaches including tendon or nerve transfer surgery have been used in individual cases to manage residual impairments. […] Acute management of AFM is largely supportive because there is an absence of therapeutic agents proven to alter outcomes. A substantial proportion of patients with AFM will become critically ill during the acute illness, requiring intubation due to respiratory failure or severe bulbar weakness.

• #4 Acute flaccid myelitis: cause, diagnosis, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7909727/

  Patients with AFM progress from neurological onset to nadir of weakness within hours to days. Supportive treatment with careful monitoring focused upon potential emerging vital complications is the mainstay of early management. […] There have been no prospective, controlled trials of specific medical therapies in AFM. Given that most experts believe neuroinvasive viral infection to be the primary cause of neurological disease in AFM, intravenous immunoglobulin (which has been shown to include neutralising antibodies against contemporary strains of enterovirus D68), is frequently used for its possible antiviral and immunomodulatory effects, along with a favourable adverse-effect profile. […] The potential of other alternative viral causes as major contributors to recent AFM outbreaks would appear to be diminished by clinical features, reported investigations, and epidemiological characteristics.

• #5 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. […] Currently, there are no FDA-approved drugs or biologics for treating or preventing AFM. […] 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. […] 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.

• #6

  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). […] The efficacy of IVIG to treat AFP or AFM has not been systematically studied, with data limited to case reports or case series (1). […] In order to be effective, IVIG administration as early as possible after onset of symptoms is likely required. […] There is no clear evidence that steroids are beneficial or harmful in the treatment of AFP. […] There is no clear evidence that plasma exchange is beneficial or harmful in the treatment of AFP.

• #7 Acute flaccid myelitis: cause, diagnosis, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7909727/

  Patients with AFM progress from neurological onset to nadir of weakness within hours to days. Supportive treatment with careful monitoring focused upon potential emerging vital complications is the mainstay of early management. […] There have been no prospective, controlled trials of specific medical therapies in AFM. Given that most experts believe neuroinvasive viral infection to be the primary cause of neurological disease in AFM, intravenous immunoglobulin (which has been shown to include neutralising antibodies against contemporary strains of enterovirus D68), is frequently used for its possible antiviral and immunomodulatory effects, along with a favourable adverse-effect profile. […] The potential of other alternative viral causes as major contributors to recent AFM outbreaks would appear to be diminished by clinical features, reported investigations, and epidemiological characteristics.

• #8 About AFM | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/about-afm/

  Close monitoring during the initial days of the illness is essential, as children may develop severe respiratory disease, as well as neurological compromise of respiratory muscles, heart rate, and blood pressure regulation. Because of this, an important number of affected individuals will need to be admitted to the intensive care unit to receive cardiac, respiratory, bladder, and bowel support. […] Unfortunately, no medical therapies have proven efficacy in AFM. Some treatments generally used are intravenous immunoglobulin (IVIG), IV steroids, and plasma exchange (PLEX), as they are commonly used for inflammatory disorders of the spinal cord. The purpose of these treatments is to attempt to reduce inflammation in the spinal cord and further prevent the individuals immune system from causing damage. IVIG products have demonstrated to contain neutralizing factors against the enterovirus D68, and its more frequently used in the setting of AFM. The use of steroids and PLEX is controversial, as they might have a negative impact on the immune systems ability to fight viral infections.

• #9 About AFM | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/about-afm/

  Close monitoring during the initial days of the illness is essential, as children may develop severe respiratory disease, as well as neurological compromise of respiratory muscles, heart rate, and blood pressure regulation. Because of this, an important number of affected individuals will need to be admitted to the intensive care unit to receive cardiac, respiratory, bladder, and bowel support. […] Unfortunately, no medical therapies have proven efficacy in AFM. Some treatments generally used are intravenous immunoglobulin (IVIG), IV steroids, and plasma exchange (PLEX), as they are commonly used for inflammatory disorders of the spinal cord. The purpose of these treatments is to attempt to reduce inflammation in the spinal cord and further prevent the individuals immune system from causing damage. IVIG products have demonstrated to contain neutralizing factors against the enterovirus D68, and its more frequently used in the setting of AFM. The use of steroids and PLEX is controversial, as they might have a negative impact on the immune systems ability to fight viral infections.

• #10 Acute flaccid myelitis | Great Ormond Street Hospital

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

  Plasma exchange, or plasmapheresis, is a procedure that washes the blood, removing plasma, the part of the blood which contains antibodies, from the blood cells and replaces the plasma with a different fluid (usually albumin). Currently, there are no recommendations for using antiviral medications or other medications to damp down the immune system. […] Physiotherapy, occupational therapy and if necessary speech and language support are important aspects of treatment to maintain. Detailed assessment should start soon after diagnosis and will be needed on a long term basis. […] In cases where outcome is poor, a procedure called nerve transfer may be suggested. This surgical procedure re-routes nerves so that they connect with areas where the previous nerve supply has been damaged. This is usually considered in the first 9 to 12 months after diagnosis when it is most likely to be successful. […] Functional electronic stimulation has been tried in similar conditions with some success. This involves implanting a stimulator to make affected muscles work using electrical impulses.

• #11 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. […] Currently, there are no FDA-approved drugs or biologics for treating or preventing AFM. […] 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. […] 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.

• #12 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 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. […] 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.

• #13 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 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. […] 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.

• #14 Acute Flaccid Myelitis (AFM) | Acute Treatments | SRNA

  https://wearesrna.org/living-with-myelitis/disease-information/acute-flaccid-myelitis/acute-treatments/

  Specific treatments and interventions for AFM have not yet been identified, but some of the treatments available for transverse myelitis have been used, including high dose intravenous (IV) steroids, intravenous immunoglobulin (IVIG), and plasma exchange (PLEX). […] The purpose of the treatments is to attempt to reduce inflammation in the spinal cord and further prevent the individuals immune system from causing damage. […] IVIG has antibodies that may limit inflammation or replication of enteroviruses and is widely used in treating AFM. […] The data on use of steroids or PLEX are mixed. […] Fluoxetine was used in several centers in the US in 2016 and was well tolerated but was not associated with improved outcomes among treated children. […] As is usual with treatment of rare neuroimmune disorders in which placebo-controlled trials are difficult to perform, treatment must be individualized. […] Early initiation of physical and occupational therapy is recommended to decrease the development of secondary consequences of AFM.

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

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

  While there is great uncertainty about the final outcome of children afflicted with AFM there is one thing that experts across the country all agree upon; 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. […] We apply the principles of ABRT and create aggressive, individualized treatment plans that have your child’s well-being at the program’s core. […] Treatment can include functional electrical stimulation, standing and weight bearing, partial body weight supported gait training and aquatic therapy. […] Rehabilitation for children with AFM requires persistence and evolving knowledge.

• #16 About AFM | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/about-afm/

  Early initiation of physical, occupational, and speech therapy services in the intensive care units is essential. Additionally, engaging family members in the process of recovery since the acute setting is also very important. […] Appropriate rehabilitation is the best treatment for AFM. […] Physical, occupational and speech therapy should be started as early as possible, even during the intensive care unit, to begin the process of restoration of functionality and prevention of secondary complications that come with immobility. […] After the child is medically stable, the main goal is to transition to an inpatient program and eventually an outpatient rehabilitation program. It has been shown that significant improvements can be achieved with a structured, multidisciplinary, and individualized rehabilitation program, even when initiated late after limb paralysis.

• #17 About AFM | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/about-afm/

  Early initiation of physical, occupational, and speech therapy services in the intensive care units is essential. Additionally, engaging family members in the process of recovery since the acute setting is also very important. […] Appropriate rehabilitation is the best treatment for AFM. […] Physical, occupational and speech therapy should be started as early as possible, even during the intensive care unit, to begin the process of restoration of functionality and prevention of secondary complications that come with immobility. […] After the child is medically stable, the main goal is to transition to an inpatient program and eventually an outpatient rehabilitation program. It has been shown that significant improvements can be achieved with a structured, multidisciplinary, and individualized rehabilitation program, even when initiated late after limb paralysis.

• #18 Rehabilitation and Recovery | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/healthcare-providers/rehabilitation-and-recovery/

  After the acute phase of AFM, medically stable children with significant residual neurologic deficits should transfer to an inpatient rehabilitation program with a multidisciplinary team. […] Intensive rehabilitation should include short-term goals to facilitate developmentally-appropriate functional independence and use of compensatory devices, while simultaneously working towards long-term goals for recovery of function and avoidance of musculoskeletal complications including muscle atrophy, bone mass loss, joint contractures, hip and/or shoulder subluxation, limb length inequality and scoliosis. […] Functional electrical stimulation (FES) can be used in conjunction with the above therapeutic modalities to facilitate muscle contraction in weak or partially denervated muscles. The motor response to electrical stimulation is noted to be decreased in patients with AFM due to lower motor neuron injury.

• #19 Improvements in Function Following Inpatient Activity-Based Therapy for Children With Acute Flaccid Myelitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33536733/

  Children with AFM who participated in ABRT increased muscle strength and made functional gains across all outcome measures. […] These results support the utility of rehabilitation in the long-term care of children with AFM and residual neurologic deficit.

• #20 About AFM | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/about-afm/

  Activity-based restorative therapy (ABRT), that should be tailored to each individual, includes weight-bearing exercise, functional electrical stimulation (FES), locomotor gait training, task-specific practice, and massed practice with high count repetitions. […] Additional rehabilitation interventions to consider are pulmonary management for those with ventilator dependence, otolaryngology care, and speech and language pathologists for those children with difficulty swallowing (dysphagia) and talking (dysphonia). […] Because AFM mainly affects growing children, continued rehabilitation with periodic rounds of activity-based therapy and ongoing specialty care including neurology and physiatry is key. […] Children with a poor recovery in an affected muscle group or diaphragm can be considered for potential nerve transfer surgery.

• #21 Rehabilitation and Recovery | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/healthcare-providers/rehabilitation-and-recovery/

  After the acute phase of AFM, medically stable children with significant residual neurologic deficits should transfer to an inpatient rehabilitation program with a multidisciplinary team. […] Intensive rehabilitation should include short-term goals to facilitate developmentally-appropriate functional independence and use of compensatory devices, while simultaneously working towards long-term goals for recovery of function and avoidance of musculoskeletal complications including muscle atrophy, bone mass loss, joint contractures, hip and/or shoulder subluxation, limb length inequality and scoliosis. […] Functional electrical stimulation (FES) can be used in conjunction with the above therapeutic modalities to facilitate muscle contraction in weak or partially denervated muscles. The motor response to electrical stimulation is noted to be decreased in patients with AFM due to lower motor neuron injury.

• #22 About AFM | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/about-afm/

  Activity-based restorative therapy (ABRT), that should be tailored to each individual, includes weight-bearing exercise, functional electrical stimulation (FES), locomotor gait training, task-specific practice, and massed practice with high count repetitions. […] Additional rehabilitation interventions to consider are pulmonary management for those with ventilator dependence, otolaryngology care, and speech and language pathologists for those children with difficulty swallowing (dysphagia) and talking (dysphonia). […] Because AFM mainly affects growing children, continued rehabilitation with periodic rounds of activity-based therapy and ongoing specialty care including neurology and physiatry is key. […] Children with a poor recovery in an affected muscle group or diaphragm can be considered for potential nerve transfer surgery.

• #23 Rehabilitation and Recovery | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/healthcare-providers/rehabilitation-and-recovery/

  Because AFM predominantly affects young, growing children who continue to improve over time, after discharge, continued rehabilitation with periodic bouts of skilled activity-based therapy should be provided to aid the acquisition of developmentally appropriate milestones and functional independence. […] Ongoing specialty care is also needed and includes neurology, physiatry, and orthopedic surgery. It is focused on the prevention and management of musculoskeletal conditions including muscle atrophy, joint and soft tissue contractures, scoliosis, shoulder and/or hip subluxation, limb length discrepancies, and loss of bone mineral density. […] Children with a poor recovery in an affected muscle group or diaphragm greater than 3 months after onset should be considered for potential nerve transfer surgery by a center experienced in the relevant procedures. The appropriate timing for nerve transfer surgery is uncertain, but a delay in consideration may result in a missed window of opportunity as muscle viability wanes with extended periods of denervation.

• #24 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20241112/New-treatment-offers-hope-for-children-with-Acute-Flaccid-Myelitis.aspx

  Researchers at Kennedy Krieger Institute’s International Center for Spinal Cord Injury (ICSCI) have made a remarkable advancement in treating children with Acute Flaccid Myelitis (AFM), a rare but severe neurological condition that causes sudden paralysis. […] A new study, published in the journal Children, demonstrates that a combination of Transcutaneous Spinal Cord Stimulation (TSS) and movement training can help children with AFM improve their ability to walk. TSS is a non-invasive therapy where electrical current is applied through pads placed on the skin to the spine. It amplifies the volume on signals traveling from the brain through the spinal cord, facilitating muscle activation and restoring motor function. […] The results were promising – three children showed improvements in walking distance, and two had measurable gains in posture, speed, and overall walking function.

• #25 New Therapy for AFM Paralysis Improves Mobility in Children | Technology Networks

  https://www.technologynetworks.com/neuroscience/news/spinal-stimulation-therapy-aids-recovery-in-children-with-afm-paralysis-393190

  Researchers at Kennedy Krieger Institutes International Center for Spinal Cord Injury (ICSCI) have made a remarkable advancement in treating children with Acute Flaccid Myelitis (AFM), a rare but severe neurological condition that causes sudden paralysis. […] A new study, published in the journal Children, demonstrates that a combination of Transcutaneous Spinal Cord Stimulation (TSS) and movement training can help children with AFM improve their ability to walk. TSS is a non-invasive therapy where electrical current is applied through pads placed on the skin to the spine. It amplifies the volume on signals traveling from the brain through the spinal cord, facilitating muscle activation and restoring motor function. […] The results were promising—three children showed improvements in walking distance, and two had measurable gains in posture, speed, and overall walking function.

• #26 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20241112/New-treatment-offers-hope-for-children-with-Acute-Flaccid-Myelitis.aspx

  Researchers at Kennedy Krieger Institute’s International Center for Spinal Cord Injury (ICSCI) have made a remarkable advancement in treating children with Acute Flaccid Myelitis (AFM), a rare but severe neurological condition that causes sudden paralysis. […] A new study, published in the journal Children, demonstrates that a combination of Transcutaneous Spinal Cord Stimulation (TSS) and movement training can help children with AFM improve their ability to walk. TSS is a non-invasive therapy where electrical current is applied through pads placed on the skin to the spine. It amplifies the volume on signals traveling from the brain through the spinal cord, facilitating muscle activation and restoring motor function. […] The results were promising – three children showed improvements in walking distance, and two had measurable gains in posture, speed, and overall walking function.

• #27 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20241112/New-treatment-offers-hope-for-children-with-Acute-Flaccid-Myelitis.aspx

  Researchers at Kennedy Krieger Institute’s International Center for Spinal Cord Injury (ICSCI) have made a remarkable advancement in treating children with Acute Flaccid Myelitis (AFM), a rare but severe neurological condition that causes sudden paralysis. […] A new study, published in the journal Children, demonstrates that a combination of Transcutaneous Spinal Cord Stimulation (TSS) and movement training can help children with AFM improve their ability to walk. TSS is a non-invasive therapy where electrical current is applied through pads placed on the skin to the spine. It amplifies the volume on signals traveling from the brain through the spinal cord, facilitating muscle activation and restoring motor function. […] The results were promising – three children showed improvements in walking distance, and two had measurable gains in posture, speed, and overall walking function.

• #28 Promising New Therapy Emerges for Children Affected by Acute Flaccid Myelitis

  https://www.zmescience.com/medicine/promising-new-therapy-emerges-for-children-affected-by-acute-flaccid-myelitis/

  Rebecca Martin, OTR/L, OTD, CPAM, and Manager of Clinical Education and Training at ICSCI and primary investigator of the study says the research shows that the combination of TSS and movement training is a safe, effective intervention that offers a new path for rehabilitation and improved quality of life. […] The results of the study were promising. Three of the children showed improvements in walking distance, and out of those three two had measurable gains in posture, speed, and overall walking function. […] Current data shows most people living with AFM tend to improve over time with physical therapy, but only less than 10% ever recover completely. Hopefully, the study and findings from the ICSCI can help improve this number, as the TSS treatment becomes accessible.

• #29 Acute flaccid myelitis (AFM)

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

  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.

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

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

  How is acute flaccid myelitis (AFM) treated? […] 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. […] 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.

• #31 Acute Flaccid Myelitis (AFM) | Nationwide Children’s Hospital

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

  Nationwide Children’s Hospital offers a team of experts focused on the treatment of children with acute flaccid myelitis. […] There is no established medical treatment or medications to cure AFM. At first, patients are treated with supportive care including hospital admission, medications such as steroids and treatments that include plasmapheresis and/or IVIG. Physical therapy and occupational therapy is very important. Kids often spend weeks to months in therapy programs. Children with AFM require treatment by a multidisciplinary team for best outcomes. […] If muscle movement does not come back a surgical procedure can be performed to help. These are called nerve transfers. A nerve transfer involves finding a healthy working nerve and connecting it to a non-working muscle. In time, the working nerve grows into the muscle and over time (9-12 months) movement can happen. This helps to rewire the nerves to give children better movement and strength in their limbs.

• #32 Rehabilitation and Recovery | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/healthcare-providers/rehabilitation-and-recovery/

  Because AFM predominantly affects young, growing children who continue to improve over time, after discharge, continued rehabilitation with periodic bouts of skilled activity-based therapy should be provided to aid the acquisition of developmentally appropriate milestones and functional independence. […] Ongoing specialty care is also needed and includes neurology, physiatry, and orthopedic surgery. It is focused on the prevention and management of musculoskeletal conditions including muscle atrophy, joint and soft tissue contractures, scoliosis, shoulder and/or hip subluxation, limb length discrepancies, and loss of bone mineral density. […] Children with a poor recovery in an affected muscle group or diaphragm greater than 3 months after onset should be considered for potential nerve transfer surgery by a center experienced in the relevant procedures. The appropriate timing for nerve transfer surgery is uncertain, but a delay in consideration may result in a missed window of opportunity as muscle viability wanes with extended periods of denervation.

• #33 Surgery Provides Hope for Acute Flaccid Myelitis (AFM) Patients

  https://www.childrenshospitals.org/news/childrens-hospitals-today/2019/03/surgery-provides-hope-for-acute-flaccid-myelitis-afm-patients

  With the help of medications and physical therapy, patients may regain some limb movement. Nerve transfer surgery is an option, but AFM’s characteristics present challenges. […] Nerve transfer surgery is an option, but AFM’s characteristics present challenges: […] Timing. Muscles typically must regain nerve supply within 18 months to restore function, so Cheng says the optimal timing for nerve transfer surgery would be nine to 12 months from AFM onset. […] Because there’s a relatively short window of time for a nerve transfer surgery to successfully treat AFM, early diagnosis and treatment is critical. […] A strong team effort is also crucial to success. […] Through nerve transfer surgery, Cheng and his colleagues—in the face of the disease’s uncertainty and challenges—can profoundly influence the lives of these patients. „It has a tremendous impact on their quality of life,” Cheng says. „In some ways, those impacts are immeasurable.”

• #34 Rehabilitation and Recovery | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/healthcare-providers/rehabilitation-and-recovery/

  Because AFM predominantly affects young, growing children who continue to improve over time, after discharge, continued rehabilitation with periodic bouts of skilled activity-based therapy should be provided to aid the acquisition of developmentally appropriate milestones and functional independence. […] Ongoing specialty care is also needed and includes neurology, physiatry, and orthopedic surgery. It is focused on the prevention and management of musculoskeletal conditions including muscle atrophy, joint and soft tissue contractures, scoliosis, shoulder and/or hip subluxation, limb length discrepancies, and loss of bone mineral density. […] Children with a poor recovery in an affected muscle group or diaphragm greater than 3 months after onset should be considered for potential nerve transfer surgery by a center experienced in the relevant procedures. The appropriate timing for nerve transfer surgery is uncertain, but a delay in consideration may result in a missed window of opportunity as muscle viability wanes with extended periods of denervation.

• #35 Acute flaccid myelitis: cause, diagnosis, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7909727/

  Nerve transfer surgery has been undertaken in some patients with poor clinical recovery of affected areas. Case series have shown generally positive outcomes from nerve transfers for restoration of elbow function in appropriately selected patients, with less positive outcomes for restoration of shoulder function. […] The extent of recovery in AFM is highly variable, although few patients (10%) recover completely. After neurological nadir (which may last days to weeks), most patients show some improvement in motor strength, with recovery being most rapid in the first few months after onset.

• #36 Acute Flaccid Myelitis — LittleArms.org

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

  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. The concept is similar to hot-wiring a car. So far, nerve transfers have shown about 80% efficacy in restoring meaningful elbow bending and straightening. Hand function restoration has even better odds. Shoulder function, however, has proven more resistant to treatment with nerve transfers, with rates of overhead reach at about 20% and rotation of the shoulder at 40%. There is limited experience with restoring the ability to breathe, but so far results are promising. 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.

• #37 Acute Flaccid Myelitis — LittleArms.org

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

  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. The concept is similar to hot-wiring a car. So far, nerve transfers have shown about 80% efficacy in restoring meaningful elbow bending and straightening. Hand function restoration has even better odds. Shoulder function, however, has proven more resistant to treatment with nerve transfers, with rates of overhead reach at about 20% and rotation of the shoulder at 40%. There is limited experience with restoring the ability to breathe, but so far results are promising. 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.

• #38 Acute Flaccid Myelitis — LittleArms.org

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

  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. The concept is similar to hot-wiring a car. So far, nerve transfers have shown about 80% efficacy in restoring meaningful elbow bending and straightening. Hand function restoration has even better odds. Shoulder function, however, has proven more resistant to treatment with nerve transfers, with rates of overhead reach at about 20% and rotation of the shoulder at 40%. There is limited experience with restoring the ability to breathe, but so far results are promising. 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.

• #39 Acute Flaccid Myelitis — LittleArms.org

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

  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. The intercostal nerve can be transferred to the phrenic nerve to regain power to the muscle. Pacers that are used to shock the diaphragm will not function long-term in patients with AFM and should be used only as temporary adjuncts to support ventilatory function until either the child recovers spontaneously or, after 9-12 months of observation, is indicated for an intercostal nerve transfer.

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

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

  How is acute flaccid myelitis (AFM) treated? […] 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. […] 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.

• #41 Acute Flaccid Myelitis — Paralysis Center

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

  AFM is a lower motor neuron paralysis. The mainstay of treatment for this condition is surgery. Milder forms of the condition can recover function over time, but severe cases will not recover sufficient function without surgical intervention. Because there is no source nerve, nerve transfers are the primary treatment. We must identify with nerve testing which nerves are the least affected and which are the most affected. We will then design a nerve transfer strategy to recover the most critical functions in that limb. Because this is a lower motor neuron injury, time is of the essence. Surgery undertaken by three months is more effective that that undertaken after nine months. […] Similar to brachial plexus injuries, there are still options if you have missed this window of opportunity. Tendon transfers and muscle transplants can still provide an opportunity to recovery lost function and a better quality of life.

• #42 Acute Flaccid Myelitis — Paralysis Center

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

  AFM is a lower motor neuron paralysis. The mainstay of treatment for this condition is surgery. Milder forms of the condition can recover function over time, but severe cases will not recover sufficient function without surgical intervention. Because there is no source nerve, nerve transfers are the primary treatment. We must identify with nerve testing which nerves are the least affected and which are the most affected. We will then design a nerve transfer strategy to recover the most critical functions in that limb. Because this is a lower motor neuron injury, time is of the essence. Surgery undertaken by three months is more effective that that undertaken after nine months. […] Similar to brachial plexus injuries, there are still options if you have missed this window of opportunity. Tendon transfers and muscle transplants can still provide an opportunity to recovery lost function and a better quality of life.

• #43 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. […] Strategies such as diaphragm pacing are being used now although there is still need for a validated demonstration of their efficacy. […] Rehabilitation strategies should be adapted to this low level of muscle tone. […] Stretching and maintaining range of motion are important to prevent contractures.

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

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

  Occupational therapy: Our occupational therapists work with patients on specific skills, such as fine motor skills and sensory processing, that help with daily activities. […] Oxygen therapy: Supplemental oxygen helps make breathing easier for people whose breathing muscles have become weak due to AFM. […] Speech-language therapy: Our speech-language pathologists help patients regain fluency, swallowing, eating and drinking, and other face, head, and neck functions. […] Nerve transfer surgery: Our highly skilled nerve surgeons repair damaged nerves by transferring nerves from a healthy area. These complex surgical procedures restore function to motor nerves to improve muscle movement.

• #45 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. […] Strategies such as diaphragm pacing are being used now although there is still need for a validated demonstration of their efficacy. […] Rehabilitation strategies should be adapted to this low level of muscle tone. […] Stretching and maintaining range of motion are important to prevent contractures.

• #46 Rehabilitation and Recovery | Acute Flaccid Myelitis Working Group

  https://acuteflaccidmyelitis.org/healthcare-providers/rehabilitation-and-recovery/

  Because AFM predominantly affects young, growing children who continue to improve over time, after discharge, continued rehabilitation with periodic bouts of skilled activity-based therapy should be provided to aid the acquisition of developmentally appropriate milestones and functional independence. […] Ongoing specialty care is also needed and includes neurology, physiatry, and orthopedic surgery. It is focused on the prevention and management of musculoskeletal conditions including muscle atrophy, joint and soft tissue contractures, scoliosis, shoulder and/or hip subluxation, limb length discrepancies, and loss of bone mineral density. […] Children with a poor recovery in an affected muscle group or diaphragm greater than 3 months after onset should be considered for potential nerve transfer surgery by a center experienced in the relevant procedures. The appropriate timing for nerve transfer surgery is uncertain, but a delay in consideration may result in a missed window of opportunity as muscle viability wanes with extended periods of denervation.

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

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

  Treatment for subluxation includes therapy to strength the muscles surrounding the joint, weight bearing through the joint, and braces or slings to help stabilize the joint. […] Therapy directed at strengthening the muscles in the neck and trunk and soft or hard braces may be recommended to slow progression. […] Those with AFM may have weakness in the neck and/or trunk muscles that can lead to curvature or twisting called scoliosis. […] Proper positioning and support in a custom wheelchair, if used, is also important in decreasing scoliosis. […] It is important to identify an orthopedist to monitor and treat these potential conditions. […] Low bone density is diagnosed with a DEXA scan. […] Those with significantly low bone density may benefit from medications to prevent ongoing the loss of bone density.

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

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

  Good nutrition, vitamin C, and avoidance of moisture all contribute to healthy skin. […] The first step in treating pain effectively is obtaining an accurate diagnosis. […] There is a long list of medications used to treat these symptoms. […] If the bladder cannot release urine, this can lead to urinary retention, urinary tract infections, and bladder or kidney stones. […] Depending on the dysfunction, treatment options include timed voiding, medicines, external catheters for males, pads, intermittent internal self-catheterization, an indwelling catheter, or electrical stimulation. […] A high-fiber diet, adequate and timely fluid intake, and medications to regulate bowel evacuations are the basic components of success. […] Individuals and caregivers of children with AFM should be aware and educated about the possible effect of AFM on mood regulation.

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

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

  Good nutrition, vitamin C, and avoidance of moisture all contribute to healthy skin. […] The first step in treating pain effectively is obtaining an accurate diagnosis. […] There is a long list of medications used to treat these symptoms. […] If the bladder cannot release urine, this can lead to urinary retention, urinary tract infections, and bladder or kidney stones. […] Depending on the dysfunction, treatment options include timed voiding, medicines, external catheters for males, pads, intermittent internal self-catheterization, an indwelling catheter, or electrical stimulation. […] A high-fiber diet, adequate and timely fluid intake, and medications to regulate bowel evacuations are the basic components of success. […] Individuals and caregivers of children with AFM should be aware and educated about the possible effect of AFM on mood regulation.

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

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

  If symptoms of depression and anxiety persist, it may warrant longer-term monitoring and possible intervention to assess for clinical anxiety or depressive disorder. […] With appropriate recognition and treatment of depression, complete depressive symptom remission is possible with proper psychotherapy and pharmacotherapy. […] 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. […] Activity-based rehabilitation includes weight-bearing exercise, functional electrical stimulation (FES), locomotor training, task-specific practice, and massed practice. […] Occupational therapists are specialists in assessing equipment needs and helping people with limited function perform activities of daily living. […] Physical therapists assist with mobility. […] The best results occur when a physician coordinates the team so that the therapists and orthotists are united on what is to be achieved.

• #51 Acute Flaccid Myelitis (AFM) | Nationwide Children’s Hospital

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

  Nationwide Children’s Hospital offers a team of experts focused on the treatment of children with acute flaccid myelitis. […] There is no established medical treatment or medications to cure AFM. At first, patients are treated with supportive care including hospital admission, medications such as steroids and treatments that include plasmapheresis and/or IVIG. Physical therapy and occupational therapy is very important. Kids often spend weeks to months in therapy programs. Children with AFM require treatment by a multidisciplinary team for best outcomes. […] If muscle movement does not come back a surgical procedure can be performed to help. These are called nerve transfers. A nerve transfer involves finding a healthy working nerve and connecting it to a non-working muscle. In time, the working nerve grows into the muscle and over time (9-12 months) movement can happen. This helps to rewire the nerves to give children better movement and strength in their limbs.

• #52 Acute Flaccid Myelitis (AFM) | Nationwide Children’s Hospital

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

  Our surgical team includes Amy Moore, MD, and Kim Bjorklund, MD. Both surgeons have been on the front line with performing nerve transfers to restore function for both in arms and legs. Dr. Moore was the first to describe nerve transfer interventions for AFM patients with lower extremity involvement and has evaluated and treated over 50 patients with AFM since 2017. Together with Dr. Bjorklund, the surgical team has the experience and expertise to improve lives in patients with AFM. […] At Nationwide Childrens, our multi-disciplinary team provides comprehensive care for patients with AFM. We are committed to providing cutting edge treatments to improve the outcomes and quality of life in our patients.

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

  https://devtest.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. […] At UT Southwestern, our neurologists develop a customized treatment plan based on each patient’s specific symptoms and overall health. Treatment options include: […] Anti-inflammatory therapies: These include corticosteroids, IVIG, and plasma exchange. […] Pain management: Medications can help relieve pain caused by AFM. […] Physical therapy: Our physical therapists guide patients through a variety of exercises to rebuild strength, balance, coordination, and other physical functions.

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

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

  How is acute flaccid myelitis (AFM) treated? […] 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. […] 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.

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

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

  During treatment, your child will be evaluated by a multidisciplinary team and recommendations will be made for medical management, home rehabilitative equipment, orthotics, and any standing/walking equipment that is appropriate for your child. […] 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)

• #56 About Acute Flaccid Myelitis | Acute Flaccid Myelitis (AFM) | CDC

  https://www.cdc.gov/acute-flaccid-myelitis/about/index.html

  Currently, there is no specific treatment for AFM, but clinicians may recommend different interventions based on each patient. […] There is no specific treatment for AFM, but a clinician who specializes in diseases like AFM may recommend certain interventions on a case-by-case basis. For example, clinicians may recommend physical or occupational therapy to help with arm or leg weakness caused by AFM. Physical rehabilitation might improve long-term outcomes if implemented during the initial phase of illness. […] CDC is working closely with national experts to better understand how to treat AFM and will update our clinical guidance with new information when available.

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