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Neuropediatrics 2015; 46(05): 307-312
DOI: 10.1055/s-0035-1558436
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Idiopathic Acute Transverse Myelitis in Children: A Retrospective Series

Spencer C. H. Kuo
1   School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
,
Wan-Hua Cho
1   School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
,
Hsin-I Shih
2   Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
,
Yi-Fang Tu
3   Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
› Author Affiliations
Further Information

Publication History

30 April 2015

21 May 2015

Publication Date:
12 August 2015 (online)

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Abstract

Objective Acute transverse myelitis (ATM) is a focal inflammatory disorder of the spinal cord, resulting in motor, sensory, and autonomic dysfunction. In this study, we delineate the clinical manifestations, neuroimaging characteristics, and outcome-associated risk factors in children with idiopathic ATM.

Methods We retrospectively reviewed the medical charts and neuroimages in nine children aged younger than 18 years diagnosed with ATM between January 2006 and August 2014.

Results The mean onset age was 5 years and 9 months. Infectious prodromes were observed in six patients. Leg weakness was observed in all patients, autonomic sphincter dysfunction was observed in seven patients, and sensory deficits on admission were observed only in four patients. The diagnosis was delayed in patients younger than 5.5 years compared with older children. The adverse outcomes cannot be predicted by the course of the disease, the laboratory findings, nor the extent of magnetic resonance imaging–detected spinal lesions; however, these outcomes can be predicted by poor early response to corticosteroids and the requirement of additional treatments (p < 0.05).

Conclusion The diagnosis of ATM is challenging in young children. Children with ATM who responded early to corticosteroids had more favorable outcomes than those who required additional therapies.

Keywords

acute transverse myelitis - pediatric - corticosteroid
 

  • References

  • 1 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59 (4) 499-505
    CrossrefPubMedGoogle Scholar
  • 2 Bhat A, Naguwa S, Cheema G, Gershwin ME. The epidemiology of transverse myelitis. Autoimmun Rev 2010; 9 (5) A395-A399
    CrossrefPubMedGoogle Scholar
  • 3 Berman M, Feldman S, Alter M, Zilber N, Kahana E. Acute transverse myelitis: incidence and etiologic considerations. Neurology 1981; 31 (8) 966-971
    CrossrefPubMedGoogle Scholar
  • 4 Debette S, de Sèze J, Pruvo JP , et al. Long-term outcome of acute and subacute myelopathies. J Neurol 2009; 256 (6) 980-988
    CrossrefPubMedGoogle Scholar
  • 5 Scott TF, Frohman EM, De Seze J, Gronseth GS, Weinshenker BG. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 77 (24) 2128-2134
    CrossrefPubMedGoogle Scholar
  • 6 Pidcock FS, Krishnan C, Crawford TO, Salorio CF, Trovato M, Kerr DA. Acute transverse myelitis in childhood: center-based analysis of 47 cases. Neurology 2007; 68 (18) 1474-1480
    CrossrefPubMedGoogle Scholar
  • 7 Defresne P, Hollenberg H, Husson B , et al. Acute transverse myelitis in children: clinical course and prognostic factors. J Child Neurol 2003; 18 (6) 401-406
    CrossrefPubMedGoogle Scholar
  • 8 Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr 1992; 121 (1) 68-74
    CrossrefPubMedGoogle Scholar
  • 9 Paine RS, Byers RK. Transverse myelopathy in childhood. AMA Am J Dis Child 1953; 85 (2) 151-163
    PubMedGoogle Scholar
  • 10 Dunne K, Hopkins IJ, Shield LK. Acute transverse myelopathy in childhood. Dev Med Child Neurol 1986; 28 (2) 198-204
    PubMedGoogle Scholar
  • 11 Knebusch M, Strassburg HM, Reiners K. Acute transverse myelitis in childhood: nine cases and review of the literature. Dev Med Child Neurol 1998; 40 (9) 631-639
    PubMedGoogle Scholar
  • 12 Wolf VL, Lupo PJ, Lotze TE. Pediatric acute transverse myelitis overview and differential diagnosis. J Child Neurol 2012; 27 (11) 1426-1436
    CrossrefPubMedGoogle Scholar
  • 13 Chen L, Li J, Guo Z, Liao S, Jiang L. Prognostic indicators of acute transverse myelitis in 39 children. Pediatr Neurol 2013; 49 (6) 397-400
    CrossrefPubMedGoogle Scholar
  • 14 Sá MJ. Acute transverse myelitis: a practical reappraisal. Autoimmun Rev 2009; 9 (2) 128-131
    CrossrefPubMedGoogle Scholar
  • 15 Alper G, Petropoulou KA, Fitz CR, Kim Y. Idiopathic acute transverse myelitis in children: an analysis and discussion of MRI findings. Mult Scler 2011; 17 (1) 74-80
    CrossrefPubMedGoogle Scholar
  • 16 Weinshenker BG, O'Brien PC, Petterson TM , et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol 1999; 46 (6) 878-886
    CrossrefPubMedGoogle Scholar
  • 17 Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidence-based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 76 (3) 294-300
    CrossrefPubMedGoogle Scholar
  • 18 Greenberg BM, Thomas KP, Krishnan C, Kaplin AI, Calabresi PA, Kerr DA. Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide. Neurology 2007; 68 (19) 1614-1617
    CrossrefPubMedGoogle Scholar
  • 19 Kaplin AI, Krishnan C, Deshpande DM, Pardo CA, Kerr DA. Diagnosis and management of acute myelopathies. Neurologist 2005; 11 (1) 2-18
    CrossrefPubMedGoogle Scholar
  • 20 Defresne P, Meyer L, Tardieu M , et al. Efficacy of high dose steroid therapy in children with severe acute transverse myelitis. J Neurol Neurosurg Psychiatry 2001; 71 (2) 272-274
    CrossrefPubMedGoogle Scholar