Acute Flaccid Myelitis: A call for vigilance and an update on management

Hopkins, Sarah E.; Desai, Jay; Benson, Leslie

Acute flaccid myelitis (AFM) is an emerging disorder defined by the acute onset of flaccid paralysis with a longitudinally extensive, gray matter predominant, lesion of the spinal cord. AFM presents as asymmetric, proximal more than distal, weakness of one or more extremities and may cause rapid respiratory decline. Early recognition and testing are essential to monitor for complications and maximize yield of testing for infectious agents, and thus contribution to surveillance. There is no human data to support specific recommendations for treatment. However, it is encouraging that monoclonal antibodies to enterovirus D68 limit the course of disease and improve outcomes in a mouse model. Patients show functional improvement over time with multimodal rehabilitation services and consideration of nerve transfer surgery, but most have lasting sequelae. We provide basic recommendations for educating front line providers, initial testing and management, and long term monitoring for complications.