Kumaran Deiva1, Michael Absoud2, Cheryl Hemingway2, Yaiza Hernandez2, Béatrice Hussson2, Hélène Maurey2, Giorgios Niotakis2, Evangeline Wassmer2, Ming Lim2, Marc Tardieu2. 1. From Assistance Publique-Hôpitaux de Paris (K.D., H.M., M.T.), Hôpital Bicêtre, Pediatric Neurology Department, National Referral Center for Neuro-Inflammatory Diseases in Children, and University Paris Sud, Le Kremlin-Bicêtre, France; Children's Neurosciences (M.A., Y.H., M.L.), Evelina Children's Hospital at Guy's & St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London; the Department of Paediatric Neurology (C.H., G.N.), Great Ormond Street Hospital for Children, London, UK; Assistance Publique-Hôpitaux de Paris (B.H.), Hôpital Bicêtre, Pediatric Radiology Department, Le Kremlin-Bicêtre, France; and the Department of Paediatric Neurology (E.W.), Birmingham Children's Hospital, UK. kumaran.deiva@bct.aphp.fr. 2. From Assistance Publique-Hôpitaux de Paris (K.D., H.M., M.T.), Hôpital Bicêtre, Pediatric Neurology Department, National Referral Center for Neuro-Inflammatory Diseases in Children, and University Paris Sud, Le Kremlin-Bicêtre, France; Children's Neurosciences (M.A., Y.H., M.L.), Evelina Children's Hospital at Guy's & St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London; the Department of Paediatric Neurology (C.H., G.N.), Great Ormond Street Hospital for Children, London, UK; Assistance Publique-Hôpitaux de Paris (B.H.), Hôpital Bicêtre, Pediatric Radiology Department, Le Kremlin-Bicêtre, France; and the Department of Paediatric Neurology (E.W.), Birmingham Children's Hospital, UK.
Abstract
OBJECTIVE: To identify early prognostic factors of relapse and disability in children presenting with an acute idiopathic transverse myelitis (TM). METHODS: Ninety-five children with acute idiopathic TM from 2 national European cohorts (France and United Kingdom) of CNS demyelinating diseases in children were identified and studied for early factors that predict relapse and disability using logistic regression models. RESULTS: Sixteen (17%) relapsed, with a diagnosis of multiple sclerosis in 13 (14%) and neuromyelitis optica in 3 (3%). Logistic regression revealed 2 main criteria as risk factors for relapse: female sex (odds ratio [OR] 3.21, 95% confidence interval [CI] 0.88-11.78) and presence of associated brain lesions (OR 14.0, 95% CI 2.8-69.3). Twenty-eight (30%) children had a poor outcome defined by a Kurtzke Expanded Disability Status Scale score ≥4 or an American Spinal Injury Association impairment (ASIA) scale <D at last follow-up. Five factors were associated with poor outcome: female sex (OR 5.8, 95% CI 0.99-32.7), severe ASIA scale at onset (OR 33.5, 95% CI 1.8-618), gadolinium enhancement on spinal MRI (OR 24.1, 95% CI 3.78-153.88), absence of pleocytosis (OR 4.6, 95% CI 0.87-26.0), and absence of cervical or cervico-thoracic lesion on spinal MRI (OR 3.9, 95% CI 0.78-19.6). CONCLUSIONS: Early predictors of relapse and disability identified in this large childhood study of acute idiopathic TM have important utility for clinical management. Larger prospective collaborative studies are required to validate these findings, which may improve the design of clinical trials.
OBJECTIVE: To identify early prognostic factors of relapse and disability in children presenting with an acute idiopathic transverse myelitis (TM). METHODS: Ninety-five children with acute idiopathic TM from 2 national European cohorts (France and United Kingdom) of CNS demyelinating diseases in children were identified and studied for early factors that predict relapse and disability using logistic regression models. RESULTS: Sixteen (17%) relapsed, with a diagnosis of multiple sclerosis in 13 (14%) and neuromyelitis optica in 3 (3%). Logistic regression revealed 2 main criteria as risk factors for relapse: female sex (odds ratio [OR] 3.21, 95% confidence interval [CI] 0.88-11.78) and presence of associated brain lesions (OR 14.0, 95% CI 2.8-69.3). Twenty-eight (30%) children had a poor outcome defined by a Kurtzke Expanded Disability Status Scale score ≥4 or an American Spinal Injury Association impairment (ASIA) scale <D at last follow-up. Five factors were associated with poor outcome: female sex (OR 5.8, 95% CI 0.99-32.7), severe ASIA scale at onset (OR 33.5, 95% CI 1.8-618), gadolinium enhancement on spinal MRI (OR 24.1, 95% CI 3.78-153.88), absence of pleocytosis (OR 4.6, 95% CI 0.87-26.0), and absence of cervical or cervico-thoracic lesion on spinal MRI (OR 3.9, 95% CI 0.78-19.6). CONCLUSIONS: Early predictors of relapse and disability identified in this large childhood study of acute idiopathic TM have important utility for clinical management. Larger prospective collaborative studies are required to validate these findings, which may improve the design of clinical trials.
Authors: Yael Hacohen; Yu Yi Wong; Christian Lechner; Maciej Jurynczyk; Sukhvir Wright; Bahadir Konuskan; Judith Kalser; Anne Lise Poulat; Helene Maurey; Esther Ganelin-Cohen; Evangeline Wassmer; Chery Hemingway; Rob Forsyth; Eva Maria Hennes; M Isabel Leite; Olga Ciccarelli; Banu Anlar; Rogier Hintzen; Romain Marignier; Jacqueline Palace; Matthias Baumann; Kevin Rostásy; Rinze Neuteboom; Kumaran Deiva; Ming Lim Journal: JAMA Neurol Date: 2018-04-01 Impact factor: 18.302
Authors: M Absoud; J Gadian; J Hellier; P A Brex; O Ciccarelli; G Giovannoni; J Kelly; P McCrone; C Murphy; J Palace; A Pickles; M Pike; N Robertson; A Jacob; M Lim Journal: BMJ Open Date: 2015-05-25 Impact factor: 2.692
Authors: Daniel H Whittam; Alvaro Cobo-Calvo; A Sebastian Lopez-Chiriboga; Santiago Pardo; Matthew Gornall; Silvia Cicconi; Alexander Brandt; Klaus Berek; Thomas Berger; Ilijas Jelcic; Grace Gombolay; Luana Micheli Oliveira; Dagoberto Callegaro; Kimihiko Kaneko; Tatsuro Misu; Marco Capobianco; Emily Gibbons; Venkatraman Karthikeayan; Bruno Brochet; Bertrand Audoin; Guillaume Mathey; David Laplaud; Eric Thouvenot; Mikaël Cohen; Ayman Tourbah; Elisabeth Maillart; Jonathan Ciron; Romain Deschamps; Damien Biotti; Kevin Rostasy; Rinze Neuteboom; Cheryl Hemingway; Rob Forsyth; Marcelo Matiello; Stewart Webb; David Hunt; Katy Murray; Yael Hacohen; Ming Lim; M Isabel Leite; Jacqueline Palace; Tom Solomon; Andreas Lutterotti; Kazuo Fujihara; Ichiro Nakashima; Jeffrey L Bennett; Lekha Pandit; Tanuja Chitnis; Brian G Weinshenker; Brigitte Wildemann; Douglas Kazutoshi Sato; Su-Hyun Kim; Saif Huda; Ho Jin Kim; Markus Reindl; Michael Levy; Sven Jarius; Silvia Tenembaum; Friedemann Paul; Sean Pittock; Romain Marignier; Anu Jacob Journal: Mult Scler Relat Disord Date: 2020-06-02 Impact factor: 4.339