After a downturn in 2015, a rare disease affecting the nervous system is on the rise again. The CDC says 89 cases of acute flaccid myelitis has been confirmed this year in 33 states, including Texas. Five of those were in Collin, Dallas, Denton and Tarrant counties.
Interview highlights:
Dr. Benjamin Greenberg is a neurologist at UT Southwestern Medical Center and Children's Health.
Why AFM is a "polio-like" illness: “The symptoms it causes is very reminiscent of polio, which led to paralysis primarily in children. And AFM is doing the exact same thing, causing paralyzed limbs. The second reason they’re related, AFM is thought to be related to a virus in the same family of viruses as the polio virus.”
No definitive cause, but: “We have found in the majority of children with AFM that they have evidence of exposure to a virus called enterovirus D-68 – a pretty common virus to cause colds, upper respiratory infections, coughs, runny nose, sometimes stomach upset or diarrhea. And if you look at viral families, it is a cousin of polio. The trick is whether enterovirus D-68 is actually causing the paralysis, and there’s a lot of work being done to decide is it a real causation or are we being fooled, because it’s not in all the children. We can’t find it in all the children. So one possibility is that it causes paralysis in some but not all, and there are other viruses circulating? We just don’t know yet.”
AFM can occur in anyone, but mostly people under 21: “The overall majority of cases we’ve observed have been in children as young as a few months of age all the way through teenage years. In most viral illnesses, we will see certain age populations more affected than others, and it tends to be younger and older. We think it may be related to immunity. As we get older we develop immunity to different conditions, or it may relate to their developing nervous systems. They may be more prone to certain paralytic conditions then adults might be.”
Is the paralysis permanent? “Yes and no. The children we’ve been treating here in Dallas and what are colleagues have seen around the country is that children do improve. It can happen slowly, it can take even years for the improvement to happen, and it is quite variable, the degree of improvement."
Treatment of AFM: "The treatment falls into two categories. The first is the acute side when we have children in the hospital with weakness. What do we do to stop the inflammation or infection? We do not yet if AFM is caused by an infection, an infection that triggers an immune response, or just an abnormal immune response. There are three different theories that link the infection to the actual damage that occurs. We have a lot of therapies to dampen an immune response. We do not have a therapy to treat the virus. So most of our therapies in the hospital are focused on dampening down an immune response that may be causing secondary damage to the spinal cord, and hoping that the virus isn’t replicating or causing more damage."
After they finished an acute episode: "All of our therapy focuses on rehabilitation and what can we do to restore muscle function. And then for some children who have certain patterns of weakness, we have surgical colleagues who can perform so-called nerve transplants, where you take a healthy nerve from one muscle and move it to the paralyzed muscle to bring back function. So we’re constantly screening children to decide if they would be candidate for procedures such as that."
Symptoms of AFM: "The number one symptom to watch for is weakness. Usually what children will complain of is, if it’s an arm, they’re dropping objects or having difficulty holding objects, and over a period of hours or days, the weakness intensifies. And so if somebody on a Monday has a weak hand and on Tuesday it’s a wrist or an elbow, they need to be evaluated.”
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