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Prognostic Parameters of Acute Transverse Myelitis in Children
Esther Ganelin-Cohen1,2,3, Osnat Konen2,3, Yoram Nevo1,2
1Institute of Pediatric Neurology, 36739Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Insights
Pediatric acute transverse myelitis, a rare spinal cord disorder, often shows good outcomes in children. Key prognostic factors include cerebrospinal fluid pleocytosis and absence of tetraparesis.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Radiology
Background:
- Acute transverse myelitis is a rare, disabling neurological disorder affecting the spinal cord.
- Limited data exists on the specific imaging features and prognostic indicators in pediatric cases.
Purpose of the Study:
- To characterize the clinical and magnetic resonance imaging (MRI) findings in pediatric idiopathic acute transverse myelitis.
- To identify clinical and imaging features that predict patient prognosis.
Main Methods:
- Retrospective review of a tertiary pediatric medical center database (2002-2017).
- Inclusion of patients under 18 with idiopathic acute transverse myelitis, excluding those with recurrent demyelinating events.
- Analysis of clinical, laboratory, MRI findings, and patient outcomes.
Main Results:
- 23 children (mean age 10 years) were included; mean follow-up was 6 years 10 months.
- Common MRI finding was cross-sectional spinal cord involvement (70%), predominantly in the thoracic region (74%), averaging 8 spinal segments.
- Good prognosis predictors included cerebrospinal fluid pleocytosis, absence of tetraparesis, and prolonged time to nadir.
Conclusions:
- Most children with acute transverse myelitis experience favorable outcomes.
- Prompt diagnosis and timely treatment are crucial for improving prognosis.
- Further research with larger cohorts is needed to validate the predictive value of imaging features.
Abstract:
Acute transverse myelitis is a rare and disabling disorder. Data on the imaging features in children are sparse. The aim of this study was to describe the clinical and magnetic resonance imaging findings characteristic of pediatric idiopathic acute transverse myelitis and to identify those with prognostic value. The database of a tertiary pediatric medical center was retrospectively reviewed for patients aged less than 18 years who were diagnosed in 2002-2017 with acute transverse myelitis that was not associated with recurrence of a demyelinating autoimmune event. Data were collected on clinical, laboratory, and imaging findings and outcome. A total of 23 children (11 male, 12 female) met the study criteria. Mean age at disease onset was 10 years, and mean duration of follow-up was 6 years 10 months. Spinal cord and brain magnetic resonance imaging scans were performed on admission or shortly thereafter. The most common finding was cross-sectional involvement, in 16 patients (70%). The mean number of involved spinal segments was 8. The most frequently involved region was the thoracic spine, in 17 patients (74%). Clinical factors predicting good prognosis were cerebrospinal fluid pleocytosis, absence of tetraparesis, and prolonged time to nadir. In conclusion, most children with acute transverse myelitis appear to have a good outcome. Prompt diagnosis and treatment are important. Further research is needed in a larger sample to evaluate the predictive value of imaging features.
