Pediatric transverse myelitis

Michael Absoud, Benjamin M. Greenberg, Ming Lim, Tim Lotze, Terrence Thomas, Kumaran Deiva

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions.

Original languageEnglish (US)
Pages (from-to)S46-S52
JournalNeurology
Volume87
Issue number9
DOIs
StatePublished - Aug 30 2016

Fingerprint

Transverse Myelitis
Pediatrics
Neuromyelitis Optica
Multiple Sclerosis
Myelin-Oligodendrocyte Glycoprotein
Spinal Cord Diseases
Delivery of Health Care
Recurrence

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Absoud, M., Greenberg, B. M., Lim, M., Lotze, T., Thomas, T., & Deiva, K. (2016). Pediatric transverse myelitis. Neurology, 87(9), S46-S52. https://doi.org/10.1212/WNL.0000000000002820

Pediatric transverse myelitis. / Absoud, Michael; Greenberg, Benjamin M.; Lim, Ming; Lotze, Tim; Thomas, Terrence; Deiva, Kumaran.

In: Neurology, Vol. 87, No. 9, 30.08.2016, p. S46-S52.

Research output: Contribution to journalArticle

Absoud, M, Greenberg, BM, Lim, M, Lotze, T, Thomas, T & Deiva, K 2016, 'Pediatric transverse myelitis', Neurology, vol. 87, no. 9, pp. S46-S52. https://doi.org/10.1212/WNL.0000000000002820
Absoud M, Greenberg BM, Lim M, Lotze T, Thomas T, Deiva K. Pediatric transverse myelitis. Neurology. 2016 Aug 30;87(9):S46-S52. https://doi.org/10.1212/WNL.0000000000002820
Absoud, Michael ; Greenberg, Benjamin M. ; Lim, Ming ; Lotze, Tim ; Thomas, Terrence ; Deiva, Kumaran. / Pediatric transverse myelitis. In: Neurology. 2016 ; Vol. 87, No. 9. pp. S46-S52.
@article{c925c93c22764510b7a2d1f7c7ea156f,
title = "Pediatric transverse myelitis",
abstract = "Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20{\%} of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions.",
author = "Michael Absoud and Greenberg, {Benjamin M.} and Ming Lim and Tim Lotze and Terrence Thomas and Kumaran Deiva",
year = "2016",
month = "8",
day = "30",
doi = "10.1212/WNL.0000000000002820",
language = "English (US)",
volume = "87",
pages = "S46--S52",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Pediatric transverse myelitis

AU - Absoud, Michael

AU - Greenberg, Benjamin M.

AU - Lim, Ming

AU - Lotze, Tim

AU - Thomas, Terrence

AU - Deiva, Kumaran

PY - 2016/8/30

Y1 - 2016/8/30

N2 - Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions.

AB - Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions.

UR - http://www.scopus.com/inward/record.url?scp=85003434307&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85003434307&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000002820

DO - 10.1212/WNL.0000000000002820

M3 - Article

VL - 87

SP - S46-S52

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 9

ER -