Acute partial transverse myelitis: risk factors for conversion to multiple sclerosis

Abstract

Acute partial transverse myelitis (APTM) may be the first clinical manifestation of multiple sclerosis (MS), of relapsing myelitis, or remain a monophasic event. Identification of risk factors associated with relapse or conversion to MS is important, as prognostic information might help to guide management. The objective of this study was to define clinical, laboratory and neuroimaging factors in patients with first-ever APTM that predict relapses or conversion to MS. We identified 73 patients with a first-ever APTM admitted to our institution from January 1999 to June 2005. The follow-up time ranged from 12 to 90 months (mean follow-up 46 months). Patient demographics, clinical impairment at onset and after 3 months, ancillary tests including cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), evoked potentials, recurrent and new symptoms and signs during follow-up were analysed. APTM remained a monophasic event in 35 patients (47.9%), conversion to MS occurred in 32 (43.8%) and recurred as relapsing myelitis in six patients (8.2%). According to univariate analysis, a family history of MS (P = 0.02), higher expanded disability status scale (EDSS) at onset (P = 0.03) and lesions on brain MRI (P = 0.03) were predictive factors for conversion to MS. CSF-specific oligoclonal bands (P = 0.04) or abnormal IgG-index (P = 0.04) were associated with increased risk for MS as well. In patients with a first-ever APTM, a family history of MS, high EDSS at presentation, lesions on brain MRI, CSF-specific oligoclonal bands or abnormal IgG-index may indicate an increased risk for conversion to MS.

Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings

“…19 Assessment of the risk for conversion to MS is of major importance due to the option of early initiation of immunomodulatory treatment. The performance of a brain MRI and detection of MS-typical brain lesions may be helpful for defining a subgroup at high risk for conversion to MS. 2,3 In a cohort of patients with acute transverse myelitis, MStypical MRI lesions may be detected in more than two third of the patients. 2,22 The diagnostic criteria for idiopathic transverse myelitis demand a negative brain MRI.…”

“…1 Clinical symptoms of acute transverse myelitis may include motor, sensory and autonomic dysfunction. 2,3 As transverse myelitis may be the initial manifestation of multiple sclerosis (MS), [2][3][4] often the expanded disability status scale is used for rating the extent of clinical impairment. 5 For comparison with other myelopathies, the American Spinal Injury Association (ASIA) score has proven reliable, 6 but has not been applied in large series of patients with acute transverse myelitis.…”

Acute inflammatory myelopathies

“…A retrospective case series of 73 patients with acute partial myelitis were followed for a mean of 46 months (range 12-90 months) (Sellner et al, 2008). Thirty-two patients were diagnosed with MS (44%), whereas spinal cord CIS remained a monophasic event in 35 patients (48%) and recurred as relapsing myelitis in 6 patients (8.2%).…”

Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old disease

“…6b). 79,86,[115][116][117] Back pain, radicular pain or Lhermitte's sign might appear in approximately onethird of the relapsing NMO (see Case 1 and 3). 79 Somatosensory evoked potentials can be impaired in more than 80% of cases.…”

“…54 Several other diseases should be also considered, depending on the clinical presentation and medical history, especially systemic autoimmune diseases, ischemia, toxic, metabolic, neurodegenerative and space occupying lesions. 54,116,117,155 Autoimmune diseases…”