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Determinants of prognosis of acute transverse myelitis in children
Reiko Miyazawa1, Yuka Ikeuchi, Takeshi Tomomasa
1Department of Pediatrics, Tone Central Hospital, Numata, Gunma University School of Medicine, Maebashi and Saku Central Hospital, Minamisaku, Nagano, Japan.
Insights
Younger children and those with specific neurological signs like increased reflexes or Babinski reflex had poorer outcomes for acute transverse myelitis (ATM). Steroid treatment did not improve prognosis in this study.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Acute transverse myelitis (ATM) is a severe neurological disorder with prolonged recovery and potential for lasting deficits.
- Predicting prognosis in pediatric ATM is crucial for patient management and understanding disease course.
Purpose of the Study:
- To identify key features influencing long-term neurologic outcomes in Japanese children diagnosed with acute transverse myelitis.
- To analyze the impact of demographic and acute-phase clinical characteristics on ATM prognosis.
Main Methods:
- Retrospective analysis of 50 Japanese pediatric ATM cases (1987-2001).
- Regression analysis correlating demographic and acute-phase features (age, reflexes, sex, infection, treatment) with long-term neurologic deficits.
- Dependent variable: persistence of neurologic deficits; Independent variables: various clinical and treatment factors.
Main Results:
- Younger age, absence of increased deep tendon reflexes, and absence of Babinski reflex were associated with higher likelihood of residual neurologic deficits (paraplegia, tetraplegia, sensory loss, sphincter disturbance).
- No significant correlation found between prognosis and sex, preceding infections, decreased deep tendon reflexes, time course of impairment, or timing/use of steroid therapy (prednisolone/methylprednisolone).
Conclusions:
- Age at onset and specific neurologic findings are significant predictors of outcome in pediatric acute transverse myelitis.
- Current evidence suggests steroid therapy does not improve long-term prognosis for ATM in this population.
Background:
Acute transverse myelitis (ATM) is a severe disorder; recovery requires several months and often leaves neurologic residua. To determine what features of patients with acute transverse myelitis significantly influence prognosis, the authors reviewed reports of ATM in Japanese children published in the last 15 years (from 1987 to 2001).
Methods:
The authors studied reports of 50 Japanese patients (17 boys, 26 girls, 7 children of unspecified sex; mean age +/- SD, 8.0 +/- 3.8 years). Acute-phase and demographic features including age, increased deep tendon reflexes, Babinski reflex, sex, preceding infection, decreased deep tendon reflexes, time course of peak neurologic impairment, treatment with prednisolone and/or high-dose methylprednisolone, and the day of illness when treatment was started were used as independent variables in a regression analysis. The dependent variable was long-term persistence of neurologic deficits.
Results:
Younger patients and those without increased deep tendon reflexes or a Babinski reflex were more likely to have residual neurologic deficits such as paraplegia or tetraplegia, sensory loss and sphincter disturbance. No relationship was seen between prognosis and sex, preceding infections, decreased deep tendon reflexes, time course of peak neurologic impairment, treatment with prednisolone or high-dose methylprednisolone, or timing of treatment initiation.
Conclusions:
Age at onset and neurologic features were important for outcome prediction in ATM. Steroid therapy did not associate with better outcome.
