Acute Flaccid Myelitis — Treatment — Clinical Pathway: Emergency and Inpatient

Evaluation of Suspected Acute Flaccid Myelitis Clinical Pathway — Emergency and Inpatient

Treatment

General

There is no clinical trial data to support a specific therapy in AFM.

Given that AFM is thought to be the result of neuroinvasive enteroviral disease, intravenous immunoglobulin is administered in hopes that the enterovirus neutralizing antibodies it contains will provide some benefit.

It is plausible that the earliest possible administration of IVIG would be the most likely to have an effect. Initiate treatment as soon as possible.

Animal models suggest increased efficacy of treatment within 24 hours of clinical diagnosis.

Review Treatment Plan with Neurology

 
Medication
Dose
Considerations
First Line
  • 2 g/kg as a single dose over 1 day
  • Pay attention to total volume of fluid administered
Second Line

Discuss the need for second line treatment with Neurology
  • Methylprednisolone
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  •  
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  • Plasma Exchange
  • 20-30 mg/kg/day (max 1000 mg/day) for 3-5 days
  • Steroids and plasma exchange are not typically indicated for the treatment of AFM, particularly in the setting of acute febrile illness and positive enteroviral testing.
  •  
  • Steroids
  • Typically reserved for malignant spinal cord swelling.
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  • Plasma Exchange
  • May be considered in certain cases with significant cord swelling and in conjunction with consulting neuroimmunologist.

Note:   Ensure any antibody testing in addition to a Save Our Specimen samples are obtained before treatment.