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Prognostic predictors of acute transverse myelitis
J Kalita1, U K Misra, S K Mandal
1Department of Neurology, SGPGIMS, Lucknow, India.
Introduction:
The role of clinical, MRI and neurophysiological parameters in predicting the outcome of acute transverse myelitis (ATM) is reported.
Materials And Methods:
Thirty-one patients with ATM were subjected to clinical, MRI, somatosensory and motor evoked potential studies in both upper and lower limbs and concentric needle electromyography. The outcome was defined at the end of 6 months into poor (Barthel Index score <12) and good (> or =12). The relationship of various prognostic variables was evaluated by biserial correlation coefficient and stepwise discriminant analysis.
Results:
The mean age of the patients was 30.4 years and 7 were females. Fifteen patients had good and 16 had poor outcome. The variables significantly related to the outcome included severity of weakness, denervation on EMG and unrecordable central motor conduction time to tibialis anterior (CMCT-TA) and tibial somatosensory evoked potentials (SEPs). Combination of severity of weakness and EMG had 90.3% predicting power. Addition of central sensory conduction time (CSCT) or central motor conduction time (CMCT) did not offer further advantage.
Conclusion:
Severity of weakness and denervation on EMG are most useful for predicting the outcome of ATM at 6 months although in early stage motor and somatosensory evoked potentials may be used instead of EMG.