Prognosis & Management
The spectrum of recovery from TM is broad, and ranges from no improvement in symptoms to complete recovery. Some improvement in symptoms can be appreciated during acute treatment, but may not be appreciable until 1-3 months later. Historical data, not controlling for treatment, suggested that approximately 1/3 of individuals recover with little or only minor symptoms, 1/3 are left with a moderate degree of permanent disability and 1/3 have virtually no recovery and are left severely functionally disabled. These data, however, predate a number of more aggressive treatment protocols and are likely inaccurate. In present day experiences the outcomes seem to be better than this distribution, with most persons with TM showing good to fair recovery. Some studies have suggested that certain clinical features (rapid progression of symptoms, back pain) and clinical studies (such as evoked potential tests or markers of injury in the spinal fluid) are often indicators of a less complete recovery. These markers are imperfect and do not assume aggressive rehabilitation or treatment strategies.
TM can be the presenting feature of multiple sclerosis. In individuals with acute partial transverse myelitis and normal brain MRI, about 10-33 percent develop MS over a five to ten-year period. Those who are ultimately diagnosed with MS are more likely to have asymmetric clinical findings, predominant sensory symptoms with relative sparing of motor systems, lesions extending over fewer than 2 spinal segments, abnormal brain MRI, and oligoclonal bands in the CSF.