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Longitudinally extensive transverse myelitis

W Oliver Tobin1, Brian G Weinshenker, Claudia F Lucchinetti

  • 1Department of Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Current Opinion in Neurology
|May 6, 2014
PubMed
Abstract

Insights

Longitudinally extensive transverse myelitis (LETM) is a heterogeneous condition. New diagnostic tests and treatments for neuromyelitis optica (NMO) are available, but other causes of LETM must be excluded in NMO-IgG-seronegative patients.

Area of Science:

  • Neurology
  • Immunology

Background:

  • Longitudinally extensive transverse myelitis (LETM) is a severe neurological condition often associated with neuromyelitis optica (NMO).
  • Advances in NMO diagnosis and therapy have emerged, yet LETM can stem from various causes.
  • Investigating alternative etiologies for myelopathy in LETM patients is crucial.

Purpose of the Study:

  • To review recent advancements in the diagnosis and treatment of NMO.
  • To discuss the differential diagnosis of LETM, particularly in NMO-IgG-seronegative cases.

Main Methods:

  • Review of current literature on NMO and LETM.
  • Analysis of diagnostic assays for NMO-IgG, including fluorescence-activated cell sorting (FACS).
  • Evaluation of therapeutic strategies for NMO spectrum disorders.

Main Results:

  • FACS and cell binding assays offer the highest sensitivity for detecting NMO spectrum disorders.
  • Patients with suspected NMO and negative results from older assays should be retested using FACS.
  • Eculizumab is a potential novel therapy for active NMO, especially after failure of azathioprine and rituximab.

Conclusions:

  • LETM represents a diverse group of conditions.
  • While NMO has new treatment options, identifying alternative causes is essential for NMO-IgG-seronegative patients.

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