Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology

T. F. Scott, Elliot Frohman, J. De Seze, G. S. Gronseth, B. G. Weinshenker

Research output: Contribution to journalArticle

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Abstract

Objective: To assess the evidence for diagnostic tests and therapies for transverse myelitis (TM) and make evidence-based recommendations. Methods: A review of the published literature from 1966 to March 2009 was performed, with evidence-based classification of relevant articles. Recommendations: Level B recommendations: neuromyelitis optica (NMO)-immunoglobulin G (IgG) antibodies should be considered useful to determine TM cause in patients presenting with clinica acute complete transverse myelitis (ACTM) features. The presence of NMO-IgG antibodies (aquaporin-4-specific antibodies) should be considered useful in determining increased TM recurrence risk. Level C recommendations: in suspected TM, distinction between ACTM or acute partial transverse myelitis may be considered useful to determine TM etiology and risk for relapse (more common with APTM). Age and gender may be considered useful to determine etiology in patients presenting with TM syndrome, with spinal infarcts seen more often in older patients and more female than male patients having TM due to multiple sclerosis (MS). Brain MRI characteristics consistent with those of MS may be considered useful to predict conversion to MS after a first partial TM episode. Longer spinal lesions extending over >3 vertebral segments may be considered useful in determining NMO vs MS. CSF examination for cells and oligoclonal bands may be considered useful to determine the cause of the TM syndrome. Plasma exchange may be considered in patients with TM who fail to mprove after corticosteroid treatment. Rituximab may be considered in patients with TM due to NMO to decrease the number of relapses. Level U recommendations: there is insufficient evidence to support or refute the efficacy of other TM therapies or the usefulness of ethnicity to determine the cause of a subacute myelopathy.

Original languageEnglish (US)
Pages (from-to)2128-2134
Number of pages7
JournalNeurology
Volume77
Issue number24
DOIs
StatePublished - Dec 13 2011

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Transverse Myelitis
Biomedical Technology Assessment
Guidelines
Neuromyelitis Optica
Therapeutics
Multiple Sclerosis
Evaluation
Technology Assessment
Transverse
Recurrence
Antibodies
Immunoglobulin G
Aquaporin 4
Oligoclonal Bands
Plasma Exchange
Spinal Cord Diseases

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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Evidence-based guideline : Clinical evaluation and treatment of transverse myelitis: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. / Scott, T. F.; Frohman, Elliot; De Seze, J.; Gronseth, G. S.; Weinshenker, B. G.

In: Neurology, Vol. 77, No. 24, 13.12.2011, p. 2128-2134.

Research output: Contribution to journalArticle

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