Demyelinating disorders: Update on transverse myelitis
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Transverse myelitis (TM) is a focal inflammatory disorder of the spinal cord. Perivascular monocytic and lymphocytic infiltration, demyelination, and axonal injury are prominent histopathogic features of TM. The clinical manifestations of TM are consequent to dysfunction of motor, sensory, and autonomic pathways. At peak deficit, 50% of patients with TM are completely paraplegic (with no volitional movements of legs), virtually all have some degree of bladder dysfunction, and 80% to 94% have numbness, paresthesias, or band-like dysesthesias. Longitudinal case series of TM reveal that approximately one third of patients recover with little to no sequelae, one third are left with a moderate degree of permanent disability, and one third have severe disability. Recent studies have shown that the cytokine interleukin-6 may be a useful biomarker, as the levels of interleukin-6 in the cerebrospinal fluid of acute TM patients strongly correlate with and are highly predictive of disability. Clinical trials testing the efficacy of promising axonoprotective agents in combination with intravenous steroids in the treatment of TM are currently underway.
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References and Recommended Reading
- 2.Transverse Myelitis Consortium Working Group: Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002, 59:499–505. This manuscript established a new set of criteria for TM that distinguished it from noninfkammatory myelopathies and distinguished idiopathic TM from TM associated with either systemic inflammatory disease or from multifocal CNS disease.Google Scholar
- 6.Altrocchi PH: Acute transverse myelopathy. Arch Neurol 1963, 9:21–29.Google Scholar
- 7.Paine RS, Byers RK: Transverse myelopathy in childhood. AMA Am J Dis Child 1968, 85:151–163.Google Scholar
- 21.Kaplin AI, Krishnan C, Deshpande DM, et al.: Diagnosis and management of acute myelopathies. Neurologist 2005, 11:2–18. This review article provides details on the paraclinical and clinical features of a large cohort of patients with TM and presents some of the pathologic features of TM.PubMedCrossRefGoogle Scholar
- 29.Weinshenker BG: Plasma exchange for severe attacks of inflammatory demyelinating diseases of the central nervous system. J Clin Apheresis 2001, 16:39–42. This manuscript is one of several from the same group showing that plasma exchange is effective in severe CNS inflammatory disorders.PubMedCrossRefGoogle Scholar
- 32.Keegan M, Pineda AA, McClelland RL, et al.: Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 2002, 58:143–146. After the initial study, which showed that plasma exchange is effective in monosymptomatic CNS inflammatory disorders, this study defined clinical characteristics that predicted who responded to it.PubMedCrossRefGoogle Scholar
- 33.Wollinsky KH, Hulser PJ, Brinkmeier H, et al.: CSF filtration is an effective treatment of Guillain-Barre syndrome: a randomized clinical trial. Neurology 2001, 57:774–780. This is a novel study examining cerebrospinal fluid filtration in patients with Guillain-Barré syndrome compared with the accepted therapy, plasma exchange. The exciting finding was that cerebrospinal fluid filtration—accomplished by repeated exchange through a filter designed to remove cells, bacteria, endotoxins, immunoglobulins, and inflammatory mediators—is as effective as plasma exchange. If confirmed in larger studies, this would represent a major advance. Conceptually, this treatment would potentially be even more effective in patients with acute transverse myelitis.PubMedGoogle Scholar