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Acute idiopathic transverse myelitis in children: early predictors of relapse and disability
Kumaran Deiva1, Michael Absoud2, Cheryl Hemingway2
1From Assistance Publique-Hôpitaux de Paris (K.D., H.M., M.T.), Hôpital Bicêtre, Pediatric Neurology Department, National Referral Center for Neuro-Inflammatory Diseases in Children, and University Paris Sud, Le Kremlin-Bicêtre, France; Children's Neurosciences (M.A., Y.H., M.L.), Evelina Children's Hospital at Guy's & St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London; the Department of Paediatric Neurology (C.H., G.N.), Great Ormond Street Hospital for Children, London, UK; Assistance Publique-Hôpitaux de Paris (B.H.), Hôpital Bicêtre, Pediatric Radiology Department, Le Kremlin-Bicêtre, France; and the Department of Paediatric Neurology (E.W.), Birmingham Children's Hospital, UK. kumaran.deiva@bct.aphp.fr.
Insights
Female sex and brain lesions predict relapse in pediatric acute idiopathic transverse myelitis (TM). Female sex, severe onset, MRI findings, and cerebrospinal fluid results predict long-term disability in children with TM.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Clinical Demyelinating Diseases
Background:
- Acute idiopathic transverse myelitis (TM) is a rare neurological disorder affecting children.
- Identifying early prognostic factors is crucial for managing pediatric TM and predicting outcomes.
Purpose of the Study:
- To identify early prognostic factors for relapse and long-term disability in children diagnosed with acute idiopathic TM.
- To inform clinical management strategies and the design of future clinical trials.
Main Methods:
- A retrospective analysis of 95 children with acute idiopathic TM from French and UK cohorts.
- Logistic regression models were used to assess early predictors of relapse and disability.
Main Results:
- Female sex and brain lesions were significant predictors of relapse (17% of patients).
- Poor outcome (30% of patients) was associated with female sex, severe onset, spinal MRI gadolinium enhancement, absence of pleocytosis, and lesion location.
- Relapse diagnoses included multiple sclerosis (14%) and neuromyelitis optica (3%).
Conclusions:
- Early identification of prognostic factors for relapse and disability in pediatric TM is vital for clinical practice.
- These findings require validation in larger prospective studies to refine clinical trial designs and improve patient care.
Objective:
To identify early prognostic factors of relapse and disability in children presenting with an acute idiopathic transverse myelitis (TM).
Methods:
Ninety-five children with acute idiopathic TM from 2 national European cohorts (France and United Kingdom) of CNS demyelinating diseases in children were identified and studied for early factors that predict relapse and disability using logistic regression models.
Results:
Sixteen (17%) relapsed, with a diagnosis of multiple sclerosis in 13 (14%) and neuromyelitis optica in 3 (3%). Logistic regression revealed 2 main criteria as risk factors for relapse: female sex (odds ratio [OR] 3.21, 95% confidence interval [CI] 0.88-11.78) and presence of associated brain lesions (OR 14.0, 95% CI 2.8-69.3). Twenty-eight (30%) children had a poor outcome defined by a Kurtzke Expanded Disability Status Scale score ≥4 or an American Spinal Injury Association impairment (ASIA) scale
Conclusions:
Early predictors of relapse and disability identified in this large childhood study of acute idiopathic TM have important utility for clinical management. Larger prospective collaborative studies are required to validate these findings, which may improve the design of clinical trials.
