Assessment of Clinical Outcomes in Patients Presenting with Transverse Myelitis: A Tertiary Care Experience from a Developing Country

Abstract

Background: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM. Methods: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department of Neurology at Jinnah Medical College Hospital (JMCH), Karachi. In total 131 patients of TM were enrolled and treated as per standard protocol, and re-evaluated after eight weeks for assessment of clinical outcomes. Results: The average age of patients was 51.15 ± 6.56 years. Out of 131 cases, 36.6% of patients had full recovery and 63.4% had poor recovery while recurrence occurred in 66.7% cases. Urinary frequency was observed in 12.2% cases and incontinence in 6.9% cases. Conclusion: Acute TM has become transformed with recent developments, especially the advent of the MRI and the discovery of biomarkers.

Neuroimmunology and Novel Methods of Treatment for Acute Transverse Myelitis

“…There is currently no effective cure for ATM, and available therapies aim to alleviate symptoms by attenuating spinal cord inflammation as well as immune-mediated destruction of myelin [ 3 ]. If the acute phase of ATM is detected, initial immunotherapy aims to cease disease progression [ 4 ].…”

“…First-line standard anti-inflammatory treatments include high-dose IV corticosteroids such as methylprednisolone or dexamethasone. Additionally, second-line treatments include plasma exchange (PLEX) and IV immunoglobulin (IVIG), which are reserved as rescue therapies for steroid-unresponsive patients [ 3 , 4 , 15 ]. A retrospective study published in 2009 aimed to study the outcome of PLEX-treated versus steroid-only-treated attacks in relapsing extensive ATM appearing to be a safe add-on therapy maximizing improvement rates [ 16 ].…”

“…Further studies on ATM’s immunopathology would also allow for the identification of inflammatory triggers on the spinal cord, increase the knowledge of the cellular and humoral factors that induce such an injury, while also potentially identifying modalities to the inflammatory response [ 10 ]. Therefore, clinical trials supporting the characterization of this rare pathology will clearly allow for an augmented clinical response and better patient outcomes [ 3 ].…”

“…The incidence of ATM is estimated to be between 1 and 8 new cases per 1 million people per year, with no apparent differences between ethnicities or races. Furthermore, it is estimated that approximately 25% of the cases occur in children alone [ 2 , 3 ]. Clinically, it affects sensory, motor, and autonomic systems causing neurological deficit and long-term disability in up to one-third of the affected patients [ 3 , 4 ].…”

“…Furthermore, it is estimated that approximately 25% of the cases occur in children alone [ 2 , 3 ]. Clinically, it affects sensory, motor, and autonomic systems causing neurological deficit and long-term disability in up to one-third of the affected patients [ 3 , 4 ]. Clinical signs of ATM are propagated by an interruption in the ascending and descending neuroanatomical pathways located in the transverse plane of the spinal cord, causing a rapidly progressing muscle weakness or paralysis that initiates in lower extremities which then spreads to upper extremities, dependent on affected spinal cord level, at varying degrees of severity [ 2 , 4 ].…”