Aurora, CO—Pharmacists are probably hearing a lot about the frightening condition, acute flaccid myelitis (AFM), which has caused children to suddenly become weak in their arms or
legs, develop drooping eyelids and have difficulty swallowing, speaking, and breathing.

The CDC says the polio-like condition is not new but that concerns have increased because of the large number of reports received since 2014, when surveillance began.

The CDC offers the following information about the condition:
• Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
• Viral infections, such as those cause by enteroviruses, are common, especially in children. It is unknown and under investigation why a small number of people develop AFM while most others recover.
• AFM cases are not caused by poliovirus; the CDC said all the stool specimens from AFM patients tested negative for poliovirus.
• Public health officials said they detected coxsackievirus A16, enterovirus A71 (EV-A71), and enterovirus D68 (EV-D68) in the spinal fluid of four of 414 confirmed cases of AFM since 2014, which points to the cause of their AFM. For all other patients, no pathogen has been detected in their spinal fluid to confirm a cause.
• Most patients had onset of AFM between August and October, with increases in AFM cases every 2 years since 2014.
• More than 90% of AFM cases have occurred in children and have been reported in 44 states.

Because of that, researchers have been searching for possible treatments for AFM. A new study published in Neurology reported disappointing news on the usefulness of the antidepressant fluoxetine, however.

Background information in the article discussed how fluoxetine had been shown in preliminary studies to have antiviral effects against enterovirus D68, or EV-D68, one possible cause of acute flaccid myelitis.

“The lack of an efficacy signal for the treatments for acute flaccid myelitis evaluated in this study emphasizes the need for development and prospective evaluation of more effective treatment and prevention strategies for this potentially devastating condition,” explained study author Kevin Messacar, MD, of Children’s Hospital Colorado in Aurora.

For the retrospective study, researchers looked at the cases of 56 children with acute flaccid myelitis in 2015–2016 from 12 medical centers across the country.

The 28 children, who ranged in age from 2 to 9 years, receiving more than one dose of fluoxetine were compared to 26 children who did not receive the drug and two who had only one dose and were considered part of the untreated group. To determine effectiveness, muscle strength was measured.

The first analysis showed no difference between the two groups in muscle strength, although by the end of the study, an average of 7 months later, the children who had taken the drug actually had lower strength scores than the children who did not receive treatment.

After adjusting for factors that could affect the results, such as age, sex, other treatments the children received and their strength level at the first exam, the researchers found that, on a scale of 0 to 20 that grades muscle strength throughout all four limbs, the strength scores of children who received the drug worsened by 0.2, while the scores of those who did not receive the drug improved by 2.5.

The drug was well-tolerated by the children, with the number of side effects similar between those receiving the drug and those who did not.

While results were not positive, the study also provided more information about the background of children who develop AFM: 91% were sick before developing the symptoms, with 71% having fever and 73% having respiratory symptoms. Weakness started an average of 8.5 days after the start of the illness, study authors pointed out.

Researchers added that more than 40% of the children had an enterovirus in their system, with 36% having EV-D68. Of those receiving fluoxetine, 57% had EV-D68, compared with 14% of those who did not receive the drug.

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