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Acute transverse myelitis in children: clinical course and prognostic factors
Pierre Defresne1, Henri Hollenberg, Béatrice Husson
1Service de Neurologie, Département de Pédiatrie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium. pierre.defresne@nepe.ucl.ac.be
Insights
This study details acute transverse myelitis in children, identifying key symptoms like pain and fever. Prognostic factors for recovery were established, with 56% achieving a favorable outcome.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Clinical Medicine
Background:
- Acute transverse myelitis (ATM) is a rare neurological disorder affecting the spinal cord.
- Understanding its clinical course and prognostic factors in children is crucial for effective management.
Purpose of the Study:
- To describe the clinical course of ATM in children.
- To identify prognostic factors influencing outcomes.
- To compare pediatric findings with adult and existing pediatric data.
Main Methods:
- Retrospective study of 24 children (2-14 years) diagnosed with ATM.
- Collection of clinical features and investigation results at admission and during disease course.
- Comparison of motor, sphincter, and global outcomes with published series.
Main Results:
- Common initial symptoms included pain (88%) and fever (58%).
- Motor loss, often in lower limbs, preceded sphincter dysfunction in two-thirds of cases.
- A favorable outcome (56%) was associated with shorter plateau duration and presence of supraspinal symptoms; complete paraplegia predicted unfavorable outcomes.
Conclusions:
- ATM in children follows distinct initial, plateau, and recovery phases.
- Several prognostic factors, including time to maximal deficit and presence of supraspinal symptoms, were identified.
- Early identification of prognostic indicators can guide therapeutic strategies and patient counseling.
Abstract:
The objective of this study was to describe the clinical course of acute transverse myelitis in children, to identify prognostic factors, and to compare our findings with published data Twenty-four children, aged 2 to 14 years and admitted with a diagnosis of acute transverse myelitis, were studied. Clinical features and results of investigations were collected at admission and during the course of the disease. Motor, sphincter, and global outcomes were compared with those in the main adult and pediatric series. During the initial phase, the most common presenting symptoms were pain (88%) and fever (58%). Motor loss preceded sphincter dysfunction in two thirds of patients and became bilateral in half of the patients. When maximal deficit was achieved (plateau), the patients presented a combination of sensory, motor, and sphincter dysfunctions without radicular involvement The motor loss consistently involved the lower limbs but was inconsistent and moderate in the upper limbs. The mean duration of the plateau was 1 week. The recovery phase was characterized by a progressive improvement of all deficits. Sphincter dysfunction improved more slowly than did the other deficits. A full recovery was achieved by 31% of the patients; minimal sequelae were present in 25% and mild to severe sequelae in 44%. An unfavorable outcome was associated with complete paraplegia (P = .03) and/or a time to maximal deficit shorter than 24 hours (P = .005). A favorable outcome was associated with a plateau shorter than 8 days (P = .03), the presence of supraspinal symptoms (P = .01), and a time to independent walking shorter than 1 month (P = .01). The course of acute transverse myelitis in children proceeds through three stages, an initial phase, a plateau, and a recovery phase, each characterized by specific clinical features. The global outcome was favorable in 56% of patients. Several prognostic factors were identified.