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Partial acute transverse myelitis is a predictor of multiple sclerosis in children
P Meyer1, N Leboucq2, N Molinari3
1CHRU Montpellier, Neuropédiatrie, France INSERM U1046, Université Montpellier 1, Université Montpellier 2, France p-meyer@chu-montpellier.fr.
Insights
Acute partial transverse myelitis and brain MRI findings in children predict a later diagnosis of multiple sclerosis. This suggests closer MRI monitoring may enable earlier treatment for pediatric MS.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Clinical Research
Background:
- Acute transverse myelitis (ATM) is a rare, severe pediatric neurological condition.
- Prognostic factors for ATM, especially the risk of developing multiple sclerosis (MS), are poorly understood in children.
Purpose of the Study:
- To identify clinical course and prognostic factors following a first episode of ATM in pediatric patients.
- To investigate predictors for the subsequent diagnosis of MS after pediatric ATM.
Main Methods:
- Retrospective analysis of 30 children under 16 with a first neurological episode of ATM.
- Collection of clinical, treatment, laboratory, and MRI data for all participants.
Main Results:
- 17% of patients were subsequently diagnosed with MS.
- Acute partial transverse myelitis (OR 5) and brain MRI abnormalities at presentation predicted MS.
- The 2011 Verhey criteria demonstrated high specificity (96%) and sensitivity (80%) for MS diagnosis in this cohort.
Conclusions:
- Initial presentation of acute partial transverse myelitis and brain MRI abnormalities are significant predictors of future MS diagnosis in children.
- Enhanced brain MRI surveillance following ATM may facilitate earlier initiation of disease-modifying therapies for pediatric MS.
Background:
Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis.
Objectives:
To determine the clinical course and prognostic factors after a first episode of ATM in children.
Methods:
Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected.
Results:
Median age at onset was 11 years (range 3-15 years). Follow-up data were available for a median of 4 years (range 0.5-16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3-11), with a 60% probability of having a relapse at five years (p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%).
Conclusion:
Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.
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