Long-term follow-up of acute partial transverse myelitis
Bertrand Bourre1, Hélène Zéphir, Jean-Claude Ongagna
1Service de Neurologie, Hôpital Charles Nicolle, 1 rue de Germont, Rouen Cedex, France. bertrandbourre@gmail.com
Background:
Acute partial transverse myelitis (APTM) may be the first clinical symptom of multiple sclerosis (MS) or may remain a monophasic event.
Objectives:
To evaluate the risk of conversion to MS and long-term disability, and to determine prognosis factors for disability.
Design:
We identified patients with no previous history of neurological disease who experienced APTM between January 1998 and December 2005 and were followed up at 3 university hospitals in France. Data on the patients' demographics and clinical states during follow-up, as well as data on cerebrospinal fluid (CSF) analysis, brain and spinal cord magnetic resonance imaging (MRI), and visual evoked potentials, were analyzed.
Setting:
Neurology departments of 3 university hospitals in Lille, Strasbourg, and Rouen, France, respectively.
Patients:
A total of 85 patients with no previous history of neurological disease who experienced APTM.
Results:
The mean (SD) follow-up period was 104.8 (29.8) months. There were 57 women (67%) and 28 men (33%), with a mean (SD) age at onset of 36.7 (11.7) years. At the end of follow-up, 53 patients (62%) were classified as having MS with a mean (SD) Expanded Disability Status Scale score of 2.6 (1.8), 1 patient (1%) was classified as having postinfectious myelitis, 1 (1%) as having neuromyelitis optica, 1 (1%) as having Sjögren syndrome, and 29 (34%) still had APTM of undetermined etiology. Oligoclonal bands in CSF were more frequent in patients with MS (92%) than in patients with APTM of undetermined etiology (38%). Brain MRI results were abnormal in 87% of patients with MS and 27% of patients with APTM of undetermined etiology; visual evoked potentials were abnormal in 43% of patients with MS and 4% of patients with APTM of undetermined etiology. Oligoclonal bands in CSF (odds ratio, 15.76 [95% CI, 2.95-84.24]) and at least 1 MRI-detected brain lesion (odds ratio, 7.74 [95% CI, 2.42-24.74]) were independent predictive factors for conversion to MS.
Conclusion:
Our study confirms that abnormal brain MRI results and the presence of oligoclonal bands in CSF are 2 independent predictive factors for conversion to MS. No clinical, biological, or MRI factor at onset was predictive of long-term disability.
Insights
Acute partial transverse myelitis (APTM) can be an early sign of multiple sclerosis (MS). Abnormal brain MRI and CSF oligoclonal bands predict MS conversion, but not long-term disability.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Neuroscience
Background:
- Acute partial transverse myelitis (APTM) is a neurological condition that may herald multiple sclerosis (MS) or be a standalone event.
- Understanding the prognosis of APTM is crucial for patient management and predicting long-term outcomes.
Purpose of the Study:
- To assess the risk of conversion from APTM to MS.
- To evaluate factors influencing long-term disability in APTM patients.
- To identify prognostic indicators for disability progression.
Main Methods:
- A cohort of 85 patients with no prior neurological history experiencing APTM was followed for over 100 months.
- Data collected included demographics, clinical status, cerebrospinal fluid (CSF) analysis, brain and spinal cord MRI, and visual evoked potentials.
- Statistical analysis identified predictive factors for MS conversion.
Main Results:
- Over 60% of patients converted to MS, with a mean disability score indicating mild to moderate impairment.
- Presence of CSF oligoclonal bands (92% in MS converters) and brain MRI lesions (87% in MS converters) were significantly higher in those who developed MS.
- CSF oligoclonal bands and brain MRI lesions were independent predictors of MS conversion.
Conclusions:
- Abnormal brain MRI findings and CSF oligoclonal bands are significant predictors of conversion to MS after an initial APTM event.
- No specific clinical, biological, or MRI factor at the onset of APTM could predict the level of long-term disability.
