Partial Acute Transverse Myelitis is a Predictor of Multiple Sclerosis in Children

Meyer et al. published a study in March 2014 about the clinical course and factors contributing to the prognosis of children under the age of 16 after they were diagnosed with acute transverse myelitis (ATM). The authors reviewed the medical records of 30 children who were diagnosed with ATM at Montpellier University Hospital in France, and follow-up records for these children were available for between 6 months and 16 years after the initial presentation. The children were split into two diagnostic categories, those with acute complete transverse myelitis (ACTM) and those with acute partial transverse myelitis (APTM). 10 of the children were categorized as having APTM, which was defined as having “…incomplete or patchy involvement of at least one spinal segment, with mild to moderate weakness, asymmetric or dissociated sensory symptoms…,” and those with bladder involvement were sometimes included. The rest of the patients were categorized as having ACTM, or “…symmetric, moderate or severe loss of function.”

Meyer et al. split the patients into these two groups because studies involving adults have found that those with APTM are more likely to eventually be diagnosed with multiple sclerosis than those with ACTM. Upon presenting to the hospital, the patients were also categorized as having:

  1. Isolated transverse myelitis, meaning that they had a normal brain MRI (53% of patients),
  2. Clinically isolated syndrome, meaning they had isolated ATM with abnormal brain MRI but no encephalopathy (17% of patients),
  3. Polyfocal CIS, meaning they had more than one lesion but that they did not have encephalopathy (13% of patients),
  4. Acute disseminated encephalomyelitis (ADEM) (17% of patients), or
  5. Multiple sclerosis (no patients).

In contrast to a previous study, none of the patients had been immunized or received an allergy shot within 30 days of their first symptoms of ATM, but in this study 60% of the patients had ATM symptoms after an infection, and 17% of the patients had a minor fall or twist before their symptoms of ATM started. At the end of the follow-up period, 5 (17%) of the patients had a diagnosis of multiple sclerosis. Having APTM was associated with a five times higher risk of eventually being diagnosed with multiple sclerosis than those with ACTM. Other studies on adults have found that patients with spinal lesions less than two sections in length are more likely to eventually have a diagnosis of multiple sclerosis than those with longer lesions, but Meyer et al. found no association between the length of the lesion in the spine and a diagnosis of multiple sclerosis. Meyer et al. attributed this to the fact that they had so few children with multiple sclerosis enrolled in their study. Furthermore, higher disability score at onset was associated with not having a subsequent diagnosis of multiple sclerosis. Meyer et al. also found that children with brain lesions were more likely to subsequently receive a diagnosis of MS than children without brain lesions. Because of this risk, and the increased risk of a subsequent diagnosis of MS in children with APTM, they suggest that children with APTM get MRI of their brain every year for at least five years.

This summary was written by Gabrielle (GG) deFiebre, Research Associate at a Public Health non-profit in New York City who was diagnosed with Transverse Myelitis in 2009. GG volunteers with the Transverse Myelitis Association.

Original research: Meyer et al. Partial acute transverse myelitis is a predictor of multiple sclerosis in children. Mult Scler. 2014; 1-9.