P Meyer1, N Leboucq2, N Molinari3, A Roubertie4, M Carneiro5, U Walther-Louvier5, D Cuntz-Shadfar6, J Leydet5, R Cheminal5, G Cambonie7, B Echenne5, G Rondouin8, K Deiva9, Y Mikaeloff10, F Rivier11. 1. CHRU Montpellier, Neuropédiatrie, France INSERM U1046, Université Montpellier 1, Université Montpellier 2, France p-meyer@chu-montpellier.fr. 2. CHRU Montpellier, Neuroradiologie, France. 3. CHRU Montpellier, Service DIM, Université Montpellier 1, UMR 729 MISTEA, France. 4. CHRU Montpellier, Neuropédiatrie, France INSERM U1051, Institut de Neurosciences de Montpellier, Université Montpellier 1, Université Montpellier 2, France. 5. CHRU Montpellier, Neuropédiatrie, France. 6. CHRU Montpellier, Neuropédiatrie, France CHRU Montpellier, Neurophysiologie Clinique, France. 7. CHRU Montpellier, Réanimation Pédiatrique, France. 8. CHRU Montpellier, Neurophysiologie Clinique, France. 9. AP-HP, CHU Bicêtre, Neuropédiatrie, Le Kremlin-Bicêtre, France National Referral Center for Neuro-Inflammatory Diseases in Children, Le Kremlin-Bicêtre, France. 10. AP-HP, CHU Bicêtre, Unité de Rééducation Neurologique Infantile, Le Kremlin Bicêtre, France INSERM U669, Université Paris Sud11, France. 11. CHRU Montpellier, Neuropédiatrie, France INSERM U1046, Université Montpellier 1, Université Montpellier 2, France.
Abstract
BACKGROUND: Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis. OBJECTIVES: To determine the clinical course and prognostic factors after a first episode of ATM in children. METHODS: Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected. RESULTS: Median age at onset was 11 years (range 3-15 years). Follow-up data were available for a median of 4 years (range 0.5-16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3-11), with a 60% probability of having a relapse at five years (p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%). CONCLUSION: Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.
BACKGROUND:Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis. OBJECTIVES: To determine the clinical course and prognostic factors after a first episode of ATM in children. METHODS: Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected. RESULTS: Median age at onset was 11 years (range 3-15 years). Follow-up data were available for a median of 4 years (range 0.5-16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3-11), with a 60% probability of having a relapse at five years (p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%). CONCLUSION: Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.