Related Experiment Video
Updated: Nov 19, 2025
A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
Prognostic factors for relapse and outcome in pediatric acute transverse myelitis
Jelte Helfferich1, Arlette L Bruijstens2, Yu Yi M Wong2
1Department of Neurology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands; Department of Neurology, Erasmus Medical Center, Room Ee-2230, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Insights
Pediatric acute transverse myelitis (ATM) patients with multiple sclerosis-like features face a higher risk of relapses. Most children with ATM have good outcomes, with few experiencing poor prognosis.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Pediatric acute transverse myelitis (ATM) prognosis is challenging to predict.
- Identifying prognostic factors for relapsing disease and poor outcomes in children with ATM is crucial for clinical management.
Purpose of the Study:
- To define prognostic factors for relapsing disease in pediatric ATM.
- To identify predictors of poor outcome in pediatric ATM.
Main Methods:
- A prospective cohort study involving 49 children with a first episode of ATM.
- Assessment of factors associated with relapsing disease and poor outcome (Expanded Disability Status Scale ≥ 4) during a median follow-up of 37 months.
Main Results:
- 29% of patients experienced relapses; 18% had poor outcomes.
- Factors associated with relapses included older age, longer time to maximum symptoms, lower maximum EDSS, spinal MRI lesions, brain MRI abnormalities, and oligoclonal bands.
- Spinal cord lesions without cervical involvement were linked to poor outcomes.
Conclusions:
- Pediatric ATM patients with clinical, radiological, and laboratory features resembling multiple sclerosis (MS) are at risk for relapses.
- Absence of MS risk factors at onset indicates a low risk for relapses.
- A minority of pediatric ATM patients in this cohort experienced poor outcomes.
Objective:
It may be difficult for clinicians to estimate the prognosis of pediatric acute transverse myelitis (ATM). The aim of this study was to define prognostic factors for relapsing disease and poor outcome in pediatric ATM.
Methods:
This prospective cohort study included 49 children, 18 boys and 31 girls (median age 13.1 years, IQR 6.5-16.2) with a first episode of ATM. Factors associated with relapsing disease and poor outcome (Expanded Disability Status Scale (EDSS) ≥ 4) were assessed during a median follow-up of 37 months (IQR 18-75).
Results:
In total, 14 patients (29%) experienced ≥ 1 relapse(s) and nine patients (18%) had a poor outcome. Factors at onset associated with relapsing disease included higher age (16.1 vs. 11.6 years, p = 0.002), longer time to maximum severity of symptoms (5.5 vs. 3 days, p = 0.01), lower maximum EDSS score (4.0 vs. 6.5, p = 0.003), short lesion on spinal MRI (64 vs. 21%, p = 0.006), abnormalities on brain MRI (93 vs. 44%, p = 0.002) and presence of oligoclonal bands in cerebrospinal fluid (67 vs. 14%, p = 0.004). The only factor associated with poor outcome was presence of a spinal cord lesion on MRI without cervical involvement (56 vs. 14%, p = 0.02).
Conclusion:
Pediatric ATM patients presenting with clinical, radiological and laboratory features associated with multiple sclerosis (MS) are at risk for relapsing disease. In absence of these known MS risk factors at onset of disease these patients are at low risk for relapses. Only a minority of pediatric ATM patients in this cohort have a poor outcome.
