AFM
Acute Treatments
Specific treatments and interventions for AFM have not yet been identified, but some of the treatments available for transverse myelitis have been used, including high dose intravenous (IV) steroids, intravenous immunoglobulin (IVIG), and plasma exchange (PLEX). The purpose of the treatments is to attempt to reduce inflammation in the spinal cord and further prevent the individual’s immune system from causing damage. IVIG has antibodies that may limit inflammation or replication of enteroviruses and is widely used in treating AFM. The data on use of steroids or PLEX are mixed. Fluoxetine was used in several centers in the US in 2016 and was well tolerated but was not associated with improved outcomes among treated children. As is usual with treatment of rare neuroimmune disorders in which placebo-controlled trials are difficult to perform, treatment must be individualized. Early initiation of physical and occupational therapy is recommended to decrease the development of secondary consequences of AFM.