17991 Acute Flaccid Myelitis

Overview

Acute flaccid myelitis (AFM) is a rare but serious condition that affects the nervous system, specifically the spinal cord. It can cause sudden weakness or paralysis in the arms or legs, and sometimes affects the face, throat, and breathing muscles.

No. AFM is extremely rare. Around the world, fewer than 1 in a million people get it each year. General doctors may never see a case in their whole career.

AFM can affect anyone, but it is most common in children, especially those younger than 5 years old. It can also occur in older children and adults, but much less often.

Symptoms

Common symptoms

• Sudden weakness in one or more arms or legs
• Limp or floppy arms or legs, especially in a child
• Facial drooping or a weak smile
• Drooping eyelids
• Difficulty moving the eyes
• Trouble swallowing or speaking
• Pain in the neck, arms, or legs

Symptoms in children

• A child may suddenly refuse to use an arm or leg
• Limpness or floppiness in a limb
• Difficulty pulling themselves up or crawling
• Sudden trouble breathing or a weak cry

Symptoms in older adults

• AFM is very uncommon in older adults, but it can happen.
• Symptoms may include sudden weakness or numbness in a limb, trouble speaking, or difficulty swallowing.
• If you have any sudden weakness, always seek urgent medical care.

Causes

Main causes

• Most cases of AFM are linked to viral infections, particularly enteroviruses.
• The exact way the virus causes spinal cord injury is not fully understood.
• It may be that the body's own immune response to the virus damages the spinal cord.

Risk factors

• Being a child, especially under 5 years old
• Having a recent viral illness, such as a fever, cough, or cold
• Being around someone who is sick with a viral infection
• Not being up to date on recommended vaccines, like the polio vaccine

When to see a doctor

See a doctor urgently if:

• If you or your child develops sudden weakness in an arm or leg, facial drooping, or trouble swallowing, call your local emergency number or go to the emergency department right away.
• If symptoms are mild but new, contact your GP or primary care provider the same day.

Book a routine appointment if:

• If you have muscle weakness that is not sudden but is persistent or getting slowly worse, make an appointment with your doctor.
• If you are worried about any symptom, it is always okay to ask a healthcare professional.

Diagnosis

A doctor, usually a neurologist (a brain and nerve specialist), will examine you or your child carefully. They will ask about symptoms and any recent illness. Because AFM is rare, your doctor will look for other causes first, like Guillain-Barré syndrome or a stroke. They may also order tests.

Tests that may be done

• MRI scan of the brain and spinal cord to look for inflammation
• Lumbar puncture (a spinal tap) to examine fluid around the spinal cord
• Nerve and muscle tests, like electromyography (EMG), to see how nerves are working
• Blood and fluid samples to check for viruses

What to expect at your appointment

Diagnosis can take a few days because doctors need to rule out other conditions. Your care team will explain each step and what they find. If AFM is suspected, you will likely be referred to a specialist hospital team.

Treatment

There is no specific cure for AFM. Treatment focuses on supporting the body and helping you or your child recover. This may include help with breathing, feeding, or movement. Active rehabilitation is very important for the best possible recovery.

Self-care at home

• Follow the care plan given by your doctor or hospital team
• Get plenty of rest, but try to stay gently active as advised
• Ask for help with daily tasks if you feel weak
• Use any recommended aids, like braces, splints, or a walker
• Keep all follow-up appointments with your specialists

Medical treatments

Doctors may sometimes use treatments that calm down the immune system, such as immunoglobulin or steroid-like medicines, but these are given in a hospital and are not proven to work for everyone. There is no standard medicine that fixes the spinal cord. Care may include breathing support or help with feeding, and physiotherapy to maintain and rebuild strength.

When is surgery considered?

Surgery is not a usual treatment for AFM itself. However, in rare cases, some people may need surgery later to help with muscle tightness, joint problems, or to place a breathing tube if long-term breathing support is needed.

Living with this condition

Recovery from AFM can be slow and may take weeks or months. Some people regain most of their strength, while others may have lasting weakness, especially in one arm or leg. Your care team will work with you on a rehabilitation plan to help you be as independent as possible.

Lifestyle tips

• Take breaks when you feel tired
• Stay as active as your medical team allows
• Do stretching or strengthening exercises recommended by a physiotherapist
• Adapt your home if needed, for example with handrails or a shower chair
• Stay socially connected with family and friends

Diet and exercise

Eating a balanced, nutritious diet helps your body recover. If you have trouble swallowing, your care team may give advice on softer foods or feeding help. Exercise is important, but it should be guided by a physiotherapist to avoid overdoing it. Gentle movement can help keep muscles flexible and strong.

Mental health and emotional wellbeing

AFM can be frightening and overwhelming. It is normal to feel anxious, sad, or frustrated during recovery. For children, this can be a stressful time too. Speak with your doctor, nurse, or a counselor about how you are feeling. Your emotional health matters just as much as your physical health.

Prevention

There is no proven way to prevent AFM, but you can reduce the risk of catching the viral infections often linked to it. Wash your hands often with soap and water, avoid touching your face, and stay away from people who are sick.

Vaccines

There is no vaccine specifically for AFM. However, staying up to date on recommended vaccines, such as the polio vaccine, helps protect against infections that can cause similar nervous system problems.

Screening programmes

There is no routine screening test for AFM. It is diagnosed based on symptoms and specialist tests.

Complications

If left untreated

• If AFM is not recognized and treated promptly, weakness can become more severe
• Breathing muscles can become weak, which can be life-threatening
• Long-term disability, such as loss of movement in an arm or leg, is more likely without early supportive care

Long-term outlook

The outcome for AFM varies from person to person. Many people, especially children, improve significantly over time, sometimes within months. Others may have lasting weakness, but with good rehabilitation, support, and time, most people adapt and continue to live full and active lives. There is hope.

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