Etiologic spectrum and prognosis in noncompressive acute transverse myelopathies: An experience of 80 patients at a tertiary care facility

Pandey, Shuchit; Garg, Richa; Malhotra, Hardeep Singh; Jain, Amita; Malhotra, Kiran Preet; Kumar, Neeraj; Verma, Rajesh; Sharma, Praveen

doi:10.4103/0028-3886.222877

Cited by 7 publications

(5 citation statements)

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“…In a study conducted in India, Pandey S, et al concluded that early administration of methyl prednisolone reduces the morbidity in these patients. 16 Similar observation was made in our study. Delayed administration of methyl prednisolone, significant disability at presentation, and an extensive involvement of spinal cord irrespective of the cause, were associated with severe residual disability.…”

Section: Longitudinally Extensive Transverse Myelitis (Letm) Is Of Course Less Common But Clinicallysupporting

confidence: 91%

Role of Methyl Prednisolone in Longitudinal Extensive Transverse Myelitis (LETM) in Children

Ashfaq¹,

Javed²,

Arshad

et al. 2020

Pak J Med Sci

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Objective: The role of methyl prednisolone in longitudinal extensive transverse myelitis in children is not completely discovered in developing country like Pakistan. So this is the first study which aimed to evaluate the efficacy of methyl prednisolone in longitudinal extensive transverse myelitis in children. Methods: This is quasi experimental hospital based descriptive prospective study. The data was collected from 34 children admitted in Paediatric Neurology department through Outpatient/emergency department in Children’s Hospital and the Institute of Child Health, Lahore for period of one year from January 2018 to December 2018. The children full filling the inclusion criteria were observed before and after giving injection methyl prednisolone 30mg/kg/dose (maximum dose one Gram irrespective of the body weight) once daily for five days in the form of intravenous infusion. Results: Complete recovery was seen in 41.2% while 58.8% showed partial recovery. The correlation of response to treatment (recovery) with gender, area of spinal cord involvement, muscle power and autonomic dysfunction is found at significance level of five percent according to Chi square test. Conclusion: Early consideration and administration of methyl prednisolone in longitudinally extensive transverse myelitis in children can be beneficial and can help to reduce the morbidity. doi: https://doi.org/10.12669/pjms.36.3.1232 How to cite this:Ashfaq MA, Javed I, Arshad M, Yaseen MR. Role of Methyl Prednisolone in Longitudinal Extensive Transverse Myelitis (LETM) in Children. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1232 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Longitudinally Extensive Transverse Myelitis (Letm) Is Of Course Less Common But Clinicallysupporting

confidence: 91%

Role of Methyl Prednisolone in Longitudinal Extensive Transverse Myelitis (LETM) in Children

Ashfaq¹,

Javed²,

Arshad

et al. 2020

Pak J Med Sci

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“…8,46 In this review, 13 patients (50%, of 26) reported significant motor recovery in both lower limbs after corticosteroid/MPS injection. Similar to our observation, many studies [47][48][49][50][51] reported significant motor improvement after MPS therapy.…”

Section: Discussionsupporting

confidence: 92%

Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

Barman

Sahoo

Viswanath

et al. 2021

Am J Phys Med Rehabil

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The objective of this review was to analyze the existing data on acute inflammatory myelopathies associated with coronavirus disease 2019 infection, which were reported globally in 2020. PubMed, CENTRAL, MEDLINE, and online publication databases were searched. Thirty-three acute inflammatory myelopathy cases (among them, seven cases had associated brain lesions) associated with coronavirus disease 2019 infection were reported. Demyelinating change was seen in cervical and thoracic regions (27.3% each, separately). Simultaneous involvement of both regions, cervical and thoracic, was seen in 45.4% of the patients. Most acute inflammatory myelopathy disorders reported sensory motor and bowel bladder dysfunctions. On cerebrospinal fluid analysis, pleocytosis and increased protein were reported in 56.7% and 76.7% of the patients, respectively. Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 reverse transcriptase–polymerase chain reaction was positive in five patients. On T2-weighted imaging, longitudinally extensive transverse myelitis and short-segment demyelinating lesions were reported in 76% and 21%, respectively. Among the patients with longitudinally extensive transverse myelitis, 61% reported “moderate to significant” improvement and 26% demonstrated “no improvement” in the motor function of lower limbs. Demyelinating changes in the entire spinal cord were observed in three patients. Most of the patients with acute inflammatory myelopathy (including brain lesions) were treated with methylprednisolone (81.8%) and plasma-exchange therapy (42.4%). An early treatment, especially with intravenous methylprednisolone with or without immunoglobulin and plasma-exchange therapy, helped improve motor recovery in the patients with acute inflammatory myelopathy associated with coronavirus disease 2019.

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“…The clinical symptom further depends on the type of myelitis (partial or complete) and the area of the cord involved whether cervical, cervicothoracic, dorsal, dorsolumbar, or the entire length. Pandey et al 13 noted that majority ( n = 66, 82.5%) of his patients had longitudinally extensive transverse myelitis. Eleven patients had cervical myelitis, 32 patients had cervicothoracic myelitis, 24 patients had thoracic myelitis, and 13 patients had whole cord myelitis.…”

Section: Discussionmentioning

confidence: 88%

“…In South India, the prevalence of MS was noted as 8.3/100,000, and the prevalence of NMOSD which is an important cause of LETM was 2.6/100,000 among all demyelinating disorders. 11 12 In one study conducted by Pandey et al 13 in North India, they studied 80 patients out of which LETM was one of the most common presentation. Another study conducted in North East India which included 151 patients of noncompressive myelopathy with 35 years as their median age and a sex ratio of 1.4:1 showing a male predominance.…”

Section: Discussionmentioning

confidence: 99%

Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India

Synmon

Phukan

Sharma

et al. 2021

JNRP

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Introduction An inflammatory lesion of the spinal cord where three or more than three vertebral segments of the cord is involved is called longitudinal extensive myelitis (LETM). It has several varied causes out of which neuromyelitis optica (NMO) and its spectrum disorder have received a distinct entity. Various radiological and clinical features help us to suspect an etiology which then further guides us into the treatment protocol and prognosis of the patients. Materials and Methods A retrospective study performed in a referral center in North East India in 15 months. Thirty-two patients of LETM were enrolled based on clinical and radiological available data. An attempt was made to classify the various etiologies and correlate with their radiological findings. Results The most common etiology noted was NMO seen in 7 patients (21.8%) followed by tuberculosis (TB) (18.7%) and post-infection myelitis (18.7%). Other etiology seen was acute disseminated encephalomyelitis (6.24%), spinal cord infarct (3.12%), radiation myelitis (6.24%), Japanese encephalitis sequalae (3.12%), systemic lupus erythematosus (3.12%), and remained undiagnosed in six patients (18.7%). Radiologically, cervico-dorsal spine was most common location in NMO (71%) whereas dorsolumbar in TB (50%). The lesion was predominantly central in both NMO (100%) and TB (80%) as compared with the other causes of LETM. It was noted that more than 50% of the transverse area of the cord was involved in both NMO (71%) and TB (50%), but < 50% involvement were more common in the post-infectious and others causes of LETM. Conclusion LETM has a various differential diagnosis, infection need to be kept in mind while ruling out NMO. Radiological features can suggest or help differentiate the various etiologies of LETM but NMO and infection like TB almost has the same features except for a different cord site predilection.

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Etiologic spectrum and prognosis in noncompressive acute transverse myelopathies: An experience of 80 patients at a tertiary care facility

Abstract: A variety of inflammatory, infective, demyelinating, and autoimmune disorders present with acute transverse myelopathy. Early institution of methylprednisolone reduces the disability in these patients.

Cited by 7 publications

References 0 publications

Role of Methyl Prednisolone in Longitudinal Extensive Transverse Myelitis (LETM) in Children

Role of Methyl Prednisolone in Longitudinal Extensive Transverse Myelitis (LETM) in Children

Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India

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