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How to identify and treat acute flaccid myelitis

Acute flaccid myelitis is an inflammation, sometimes confused with polio, Guillian-Barré syndrome or traumatic neuritis, because it generates symptoms such as back pain, muscle weakness, with decreased sensitivity and legs and /or arm paralysis.

Its main characteristic is spinal inflammation that leaves the muscles very weak and soft, causing paralysis. Generally, this inflammation is caused by an infection, but it can also happen due to an autoimmune disease, which ends up attacking the cells of the spinal cord.

Although it is not always possible to cure acute flaccid myelitis completely. Although it is possible to control symptoms and restore quality of life with medication and physical therapy.

How to identify and treat acute flaccid myelitis

Symptoms of acute flaccid myelitis

The first symptoms of acute flaccid myelitis are similar to the flu, with sneezes, cough, and general malaise during 3-7 days, after this period the following symptoms emerge:

  • Spinal pain, especially in the lower back,
  • Tingling or burning sensation in the chest, abdomen, legs or arms;
  • Weakness in the arms or legs, with difficulty in holding objects or walking;
  • Inclination of the head forward, and difficulty swallowing;
  • Difficulty holding urine or feces.

Since myelitis can affect the myelin sheath of nerve cells, the transmission of nerve stimuli will be further impaired over time and therefore it is common for symptoms to worsen each day by becoming more intense, even paralysis, which prevents the person from walking.

When the lower spine is affected, the child may not walk for the rest of his life. When the affected area is near the neck, the person may lose movements of the shoulders and arms. In more severe cases, it may be difficult to breathe and swallow, and there is a need for hospitalization.

Whenever there are symptoms that may indicate a problem in the spine, it is very important to consult a general practitioner, for example, to identify the cause and start treatment before difficult lesions arise. In this situation, it is normal after the diagnosis to be referred to a neurologist.

How to confirm the diagnosis

To diagnose acute flaccid myelitis, consult a general practitioner or neurologist when there is suspicion of a spinal problem. The doctor, in addition to evaluating the symptoms and history of diseases, may ask for some diagnostic tests, such as magnetic resonance, lumbar puncture and various blood tests, which will help rule out other diseases.

What causes acute flaccid myelitis

It is not yet known what the exact cause of acute flaccid myelitis is, however, there are some conditions that seem to increase the risk of developing this problem, such as:

  • Viral infections, especially in the lungs (Mycoplasma pneumoniae) or in the digestive system;
  • Enteroviruses, such as EV-A71 and EV-D68;
  • Rhinoviruses;
  • Parasitic infections, such as toxoplasmosis or cysticercosis;
  • Multiple sclerosis;
  • Optic neuromyelitis;
  • Autoimmune diseases such as lupus or Sjogren's syndrome.

Although very rare, there are also reports of cases of acute flaccid myelitis that occurred after taking a vaccine against hepatitis B or against measles, mumps and chicken pox.

How is treatment done

The treatment of myelitis varies greatly according to each case, but is usually initiated with the use of medication to treat possible infections, reduce marrow inflammation and relieve symptoms, improving the quality of life. Some of the most commonly used drugs include:

  • Injectable corticosteroids, such as Methylprednisolone or Dexamethasone: rapidly reduce inflammation of the spinal cord and decrease the immune system response, relieving symptoms;
  • Plasma exchange therapy: is used in people who have not shown improvement with the corticosteroids injection and works by removing the antibodies in excess that may be causing the marrow inflammation;
  • Antiviral Remedies: to treat any possible viral infection that is active and damaging to the marrow;
  • Painkillers, such as Acetominofeno, also called Paracetamol or Naproxen: to relieve muscle pain and any other type of pain that may arise.

After this initial therapy, and when the symptoms are more controlled, the doctor can recommend physiotherapy sessions to help strengthen the muscles and train coordination, which may be affected by the disease. Although physical therapy can not cure the disease, it can greatly improve muscle strength, movement coordination, facilitating one's own hygiene and other day-to-day tasks.

In some cases, it may also be necessary to do occupational therapy sessions. These sessons, help the person learn how to do their daily activities with the new limitations that arose with the disease. But in many cases there is a full recovery in a few weeks or months.

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