Breaking News
March 24, 2019 - Enzyme inhibitor stops inflammation and neurodevelopmental disorders in mouse models
March 24, 2019 - Walk, Dance, Clean: Even a Little Activity Helps You Live Longer
March 24, 2019 - Americans used less eye care in 2014 versus 2008
March 24, 2019 - Study finds link between depression in 20s linked to memory loss in 50s
March 24, 2019 - New tool helps physiotherapy students to master complex fine motor skills
March 24, 2019 - The AMR Centre secures £2.3m funding boost
March 24, 2019 - Study examines effects of taking ondansetron during first trimester of pregnancy
March 24, 2019 - Researchers identify a more effective treatment for cancer
March 24, 2019 - Open-source solution for multiparametric optical mapping of the heart’s electrical activity
March 24, 2019 - New nanotechnology approach shows promise in treating triple negative breast cancer
March 24, 2019 - Trevena Announces Publication of APOLLO-1 Results in The Journal of Pain Research Highlighting Oliceridine’s Potential for Management of Moderate-to-Severe Acute Pain
March 24, 2019 - Maternal deaths following C-section 50 times higher in Africa compared to high-income countries
March 24, 2019 - Apple watch could detect irregular heart beat says study
March 24, 2019 - Queen Mary University of London’s BCI boosts radionuclide imaging capabilities with MILabs VECTor technology
March 24, 2019 - Girls should be encouraged to gain more ball skills, shows study
March 24, 2019 - Acute doses of synthetic cannabinoid can impair critical thinking and memory
March 24, 2019 - Presence of bacteria in urine does not always point to infection, shows study
March 24, 2019 - Scientists identify a new role for nerve-supporting cells
March 24, 2019 - Hidden differences between pathology of CTE and Alzheimer’s disease discovered
March 24, 2019 - Knowing causative genes of osteoporosis may open door to more effective treatments
March 24, 2019 - Toilet-seat based cardiovascular monitoring system getting ready to begin commercialization
March 24, 2019 - New model for intensive care identifies factors that send ill patients to ICU
March 24, 2019 - Recommendations Issued for HSCT in Multiple Myeloma
March 24, 2019 - Deep brain stimulation provides sustained relief for severe depression
March 24, 2019 - “Statistical significance” may soon be a thing of past?
March 24, 2019 - Researchers track effects of epigenetic marks carried by sperm chromosomes
March 24, 2019 - AHA News: Family Adopts Three Children With Three Different Heart Conditions
March 24, 2019 - Research into opioid painkillers could provide clues for safer drug development
March 23, 2019 - Lung cancer survivor recounts her lifetime struggles
March 23, 2019 - Radial and femoral approach for PCI achieve similar results in terms of survival
March 23, 2019 - Study sheds light on the optimal timing of coronary angiography in NSTEMI patients
March 23, 2019 - Excess hormones could cause a condition that can lead to blindness in women, study finds
March 23, 2019 - Dramatic shifts in first-time opioid prescriptions bring hope, concern
March 23, 2019 - Antidepressant drugs may not work when neurons are out of shape
March 23, 2019 - TTUHSC El Paso to establish endowed chair in neurology through a major grant
March 23, 2019 - New device approved by FDA for treating patients with moderate-to-severe heart failure
March 23, 2019 - People with peripheral artery disease have lower Omega-3 Index, shows research
March 23, 2019 - Trigger warnings have minimal impact on how people respond to content, shows research
March 23, 2019 - Gilead Announces Data From Two Studies Supporting Further Development of GS-6207, a Novel, Investigational HIV-1 Capsid Inhibitor as a Component of Future Long-Acting HIV Therapies
March 23, 2019 - Selfish genetic elements amplify inflammation and age-related diseases
March 23, 2019 - Study provides new understanding of how the brain recovers from damage caused by stroke
March 23, 2019 - CRISPR/Cas libraries could revolutionize drug discovery
March 23, 2019 - Allergic reaction during pregnancy may alter sexual-development in offspring’s brain
March 23, 2019 - Seeing through a robot’s eyes helps those with profound motor impairments
March 23, 2019 - Recent research shows that ease of breastfeeding after C-section differs culturally
March 23, 2019 - Newly discovered parameters offer more control over efficient release of drugs
March 23, 2019 - ‘De-tabooing’ of abortion- Women would like more support from health care community
March 23, 2019 - Anti-TB drugs can increase susceptibility to Mtb reinfection
March 23, 2019 - New survey indicates need of attention to neglected tropical diseases
March 23, 2019 - Innovative in vitro method to develop easy-to-swallow medicine for children and older people
March 23, 2019 - Sugary drinks could raise risk of early deaths finds study
March 23, 2019 - Lian wins ENGINE grant for stem-cell-based therapy to treat Type 1 diabetes
March 23, 2019 - Overall, Physicians Are Happy and Enjoy Their Lives
March 23, 2019 - Researchers discover how blood vessels protect the brain during inflammation
March 23, 2019 - CDC study shows modest improvement in optimal hospital breastfeeding policy
March 23, 2019 - Family-based prevention program to reduce alcohol use among older teens
March 23, 2019 - Remote monitoring of implanted defibrillators in heart failure patients prevents hospitalizations
March 23, 2019 - Appropriate doffing of personal protective equipment may reduce healthcare worker contamination
March 23, 2019 - Window screens can suppress mosquito populations, reduce malaria in Tanzania
March 23, 2019 - Researchers discover new biomarker for postoperative liver dysfunction
March 23, 2019 - Pregnancy history may be linked to cognitive function in older women, finds study
March 23, 2019 - Study shows ticagrelor is equally safe and effective as clopidogrel after heart attack
March 23, 2019 - FDA Approves First Drug for Postpartum Depression, Zulresso (brexanolone)
March 23, 2019 - New guidelines outline new treatment management for psoriasis
March 23, 2019 - Thermally abused cooking oil may promote progression of breast cancer
March 23, 2019 - High-fructose corn syrup fuels growth of colon tumors in mice
March 23, 2019 - Partnership aims at establishing best practices to promote diversity in clinical trials
March 23, 2019 - New study examines presence of microbes in tap water from residences, office buildings
March 23, 2019 - Early life trauma may affect brain structure, contribute to major depressive disorder
March 23, 2019 - NIH starts clinical trial of drug to treat cravings associated with opioid use disorder
March 23, 2019 - Cervix bacteria, immune factors could be a warning signal of premature birth, reports new research
March 23, 2019 - Worst-ever emergency care performance figures underscore the need to focus on staffing
March 23, 2019 - The Current issue of “The view from here” is concerned with Cancer
March 23, 2019 - Mouse model validates how ‘good’ and ‘bad’ bacteria affect acne
March 23, 2019 - Individual amygdala neurons respond to touch, imagery and sounds
March 23, 2019 - Combination of two topical creams can prevent cancer
March 23, 2019 - Study suggests depression screening when assessing African-Americans for schizophrenia
March 23, 2019 - New electronic support system for choosing drug treatment based on patient’s genotype
March 23, 2019 - First-of-its-kind study provides pregnancy statistics of imprisoned U.S. women
March 23, 2019 - Marinus Pharmaceuticals Initiates Phase 3 Study in Children with PCDH19-Related Epilepsy
5 Questions: What parents should know about poliolike illness | News Center

5 Questions: What parents should know about poliolike illness | News Center

image_pdfDownload PDFimage_print

Recently, cases of a poliolike illness have been back in the news. Acute flaccid myelitis, a rare complication from certain viral infections, causes paralysis in one or more limbs and strikes mostly children. Keith Van Haren, MD, assistant professor of neurology and neurological sciences at the School of Medicine, has studied the condition and written scientific review articles covering clusters of cases dating back to 2012.

Van Haren talked with science writer Erin Digitale about what parents should know about the disease.

Q: What do we know about the history and causes of this condition?

Van Haren: There are cases of infectious paralysis stretching far back into recorded human history, including, of course, of poliomyelitis. The best interpretation of current and historical evidence suggests these cases are primarily caused by viral infections, and there happen to be several viruses that can do this. Broadly speaking, we could classify poliomyelitis as a form of acute flaccid myelitis; they appear to share similar elements of pathophysiology.

Enteroviruses — including the three human polioviruses, and enterovirus 71 — are the most common culprits. Since at least 2012, there is accumulating evidence that enterovirus 68 can also cause this syndrome. And West Nile Virus can cause this acute flaccid myelitis, although it’s from a different family of viruses.

As best we can tell, the modern outbreaks go back to at least 2012, when Carol Glaser and her team at the California Department of Public Health began noticing an uptick in poliolike cases, mostly in kids. It was Carol who first noticed the viral association with enterovirus 68. 

The phrase “acute flaccid myelitis” was coined in 2014 by a group of colleagues, including myself, who were trying to come up with an appropriate descriptive term that would disentangle it from the historical association with poliomyelitis and provide a broader framework for characterizing the illness.

The pattern that we’re currently seeing is an every-other-year phenomenon. Different years bring different enteroviruses, just as different years bring different strains of flu. In the years enterovirus 68 has been circulating — in 2012, 2014, 2016 and 2018 — we’ve also seen an increase in cases all clustered in late summer and early fall, which is the time of year that many species of enteroviruses circulate in North America. 

Q: What happens in children affected with acute flaccid myelitis?

Van Haren: The syndrome typically begins with what looks like a traditional systemic illness. This is broadly true of many infectious neurological illnesses: What begins as an otherwise ordinary infection takes a different course in a particular patient, and it’s not understood why.

Enterovirus infections typically start and end as benign illnesses, with congestion, fever and a sense of malaise all lasting a few days. In a very small number of individuals, this illness is followed by something more ominous. The earliest symptom among patients who actually develop acute flaccid myelitis is a period of significant pain in the limb, or multiple limbs, often described as aching, tingling or electric shocks. Within the next day or so, the limb becomes weak and the weakness can progress very quickly, over the course of an hour or two even, to very weak or complete loss of function. Muscles of the face can also be affected.

The weakness may worsen for the next day or for several days before it reaches its low point and stabilizes. In many cases, the weakened limb does gradually recover, though it may not make a full recovery. Most recovery occurs in the first few months, but recovery may continue for years. We have seen apparent improvement continuing, albeit slowly, even as far out as two years after the injury.

Rehabilitation is sometimes possible once the illness is stabilized. Most rehabilitation efforts are taken on a case-by-case basis, and often include strength training and electrical stimulation devices that deliver tiny electrical pulses, applied directly over the muscle. There are also surgical approaches, in which a nerve that is not working is swapped for a nerve that is working to re-attain some muscle movement, typically in an arm, but it is not appropriate for everyone and is attempted only in very highly specialized centers. It requires a highly skilled team to identify who might benefit and plan the procedure.

Q: How worried should parents be? Is there anything they can or should do to protect their children?

Van Haren: With any infectious illness, the youngest and oldest members of population are most vulnerable. This condition is a bit of an exception, as it is primarily affecting younger children. 

To date, the best we can offer is a preventive approach: Try to help keep children healthy and clean with regular hand-washing and limited exposure to very sick people.

If a child is sick, parents should encourage him or her to rest and provide normal, appropriate nourishment and hydration. If the child or parent is noticing acute weakness or significant pain in one limb, they should seek medical care promptly.

It’s important to remember how rare this disease is. To put it in context, last year there were about 80,000 deaths across the country from the flu; so far this year, there are around 100 or so total cases of acute flaccid myelitis under investigation. Clinicians and scientists are working hard to understand how to make sure it doesn’t become more and, ideally, to eliminate it altogether. Analogous eradication efforts have occurred many times, primarily through vaccination. 

Q: What are experts doing to better understand the illness?

Van Haren: The physician community, including child neurologists and infectious disease specialists, is coming together to form working groups to tackle the problem directly. Our general sense now is that this is a serious illness for anyone who is affected, but it remains rare.

Our goal is to understand what’s happening well enough to prevent it from becoming more common, and also to develop better modes to treat it. The physician community is seeing a convergence of evidence that suggests enterovirus 68 is responsible for many but not all cases. This community would like more support from public health agencies and funders to try to understand this disease.

Q: What do we know now about the illness that we didn’t know last time there were a significant number of cases?

Van Haren: There has been some really helpful progress in past couple of years in terms of modeling around enterovirus 68, focusing on the biology of the virus. Scientists have studied the genetic alterations that may have made the virus more prone to attack the human nervous system, and have tested the ability of the virus to do this in a mouse model. This is a crucial foundation for developing treatments and vaccinations. 

It’s somewhat disappointing that we don’t yet have a good therapeutic or really specific preventive approach. Those are the areas we ought to be making ardent strides toward.

Tagged with:

About author

Related Articles