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Prognostic indicators of acute transverse myelitis in 39 children
Long Chen1, Jie Li, Zhichao Guo
1Department of Pediatrics, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing, People's Republic of China.
Insights
New criteria for acute transverse myelitis (ATM) help predict prognosis. Factors like rapid symptom onset and high cerebrospinal fluid protein indicate poorer outcomes in children with ATM.
Area of Science:
- Neurology
- Pediatrics
- Clinical Research
Background:
- The Transverse Myelitis Consortium Working Group established new diagnostic criteria for acute transverse myelitis (ATM).
- Evaluating clinical predictors of functional prognosis in pediatric ATM is crucial.
Purpose of the Study:
- To assess the relationship between clinical variables and functional prognosis in children diagnosed with ATM using the new criteria.
Main Methods:
- Retrospective review of 39 pediatric cases of ATM diagnosed between 1995 and 2008.
- Data collected included clinical-epidemiological factors and functional outcomes measured by the Modified Barthel Index.
- Mean follow-up duration was 102.7 months.
Main Results:
- Of 39 children meeting criteria, 5.1% converted to multiple sclerosis.
- Factors associated with poor prognosis included rapid progression to maximal deficits, prolonged peak neurological impairment, delayed treatment initiation, elevated cerebrospinal fluid protein, and secondary infections.
- These factors correlated with residual neurological deficits and reduced quality of life (P < 0.012).
Conclusions:
- Rapid time to maximal deficits, prolonged peak neurological impairment, delayed treatment, increased cerebrospinal fluid protein, and secondary infections are significant predictors of poor prognosis in pediatric acute transverse myelitis.
Background:
The Transverse Myelitis Consortium Working Group has proposed new diagnostic criteria for acute transverse myelitis. The purpose of the present study is to evaluate the relations between clinical variables and functional prognosis using new criteria.
Methods:
We reviewed 39 Chinese cases meeting the new criteria, recorded clinical epidemiological data, and followed activities of daily living measuring scale (Modified Barthel Index).
Results:
Thirty-nine children met new criteria for definite acute transverse myelitis in the past 14 years between 1995 and 2008. Mean follow-up time was 102.7 months. Conversion to multiple sclerosis occurred in two patients (5.1%). Those children with a short time to maximal deficits, long time of peak neurological impairment and initial time of treatment, increased protein levels of the cerebrospinal fluid, and secondary infection were more likely to have residual neurological deficits, resulting in lower qualities of life (P = 0.005, P = 0.003, P = 0.011, P = 0.0012, P = 0.000, respectively).
Conclusions:
A short time to maximal deficits, long time of peak neurological impairment and initial time of treatment, increased protein levels of cerebrospinal fluid, and secondary infection played important roles in predicting poor prognosis.
