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Acute transverse myelitis in childhood: center-based analysis of 47 cases
F S Pidcock1, C Krishnan, T O Crawford
1Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. pidcock@kennedykrieger.org
Insights
Many children experience lasting disabilities from acute transverse myelitis (ATM), with younger children facing worse outcomes. Urinary and sensory issues are common long after the initial illness.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Clinical Outcomes Research
Background:
- Acute transverse myelitis (ATM) is a rare neurological disorder affecting children.
- Understanding factors influencing long-term functional outcomes in pediatric ATM is crucial for patient management.
Purpose of the Study:
- To correlate clinical characteristics of pediatric ATM with functional outcomes.
- To identify predictors of recovery and persistent disability in children with ATM.
Main Methods:
- Retrospective chart analysis of 47 pediatric patients diagnosed with ATM.
- Clinical evaluations and functional assessments were performed.
- Longitudinal follow-up data were collected at a median of 3.2 years post-illness.
Main Results:
- Significant disability was common, with 89% experiencing severe impairment at nadir (inability to walk or requiring ventilation).
- At follow-up, 43% could not walk 30 ft, 21% required walkers, and many reported urinary issues (68% urgency, 50% catheterization) and sensory symptoms (54% dysesthesias, 75% numbness).
- Older age at diagnosis, shorter time to diagnosis, lower spinal cord lesion level, absence of T1 hypointensity on MRI, and normal CSF white blood cell count predicted better outcomes.
Conclusions:
- Children with ATM frequently experience persistent functional deficits, particularly urinary and sensory impairments.
- Younger age at onset (below 3 years) is associated with poorer functional outcomes.
- Identifying prognostic factors aids in predicting recovery trajectories and guiding therapeutic strategies.
Objective:
To relate clinical characteristics associated with acute transverse myelitis (ATM) in children with functional outcomes at follow-up.
Methods:
We identified 47 patients for whom ATM occurred under the age of 18 years. Chart analysis, clinical evaluation, and administration of functional measures were completed.
Results:
The age at onset clustered between ages 0 to 2 and 5 to 17. Febrile illness had occurred in 47% and vaccination in 28%. Major disability at the nadir of the clinical course was noted. Eighty-nine percent were unable to walk, required assisted ventilation, or both. At a median of 3.2 years after acute illness, 43% were unable to walk 30 ft and 21% required a walker or other support, 68% experienced urinary urgency, 50% required bladder catheterization, 54% were troubled by persistent dysesthesias, and 75% had numbness. Factors associated with a better functional outcome included older age at time of diagnosis, shorter time to diagnosis, lower sensory and anatomic levels of spinal injury, absence of T1 hypointensity on spinal MRI obtained during the acute period, lack of white blood cells in the CSF, and fewer affected spinal cord segments. Neither rapid progression to maximum impairment in less than 1 day nor any antecedent illness, immunization, or trauma was associated with a worse outcome.
Conclusion:
Persisting disability was present in many children with acute transverse myelitis. Urinary problems and sensory symptoms were the most common issues. Age at onset below 3 years was associated with worse functional outcomes.
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