Is methyl prednisolone useful in acute transverse myelitis?
METHODS
Hospital based observational study.


OBJECTIVE
To evaluate the role of methyl prednisolone (MPS) in the management of acute transverse myelitis (ATM).


METHODS
Twenty-one patients with ATM were included in a prospective hospital based study during 1992-1997. All the patients underwent neurological examination, spinal MRI, somatosensory and motor evoked potentials of both upper and lower limbs and concentric needle EMG study. Twelve consecutive patients did not receive MPS therapy who were managed during 1992-1994 and nine consecutive patients during 1995-1997 received MPS therapy in a dose of 500 mg i.v. for 5 days. The clinical and neurophysiological studies were repeated 3 months later. The outcome was defined on the basis of Barthel index (BI) score at the end of 3 months into good (BI> or =12) and poor (BI<12).


RESULTS
The age of MPS group was 25.5 years (range 12-42) and three were females. The age of non MPS group was 33.5 years (range 16-70) and two were females. In the MPS group 33% had poor outcome compared to 67% in the non MPS group. In the MPS group mean admission BI score was 7.3 which improved to 14.6 after MPS therapy. In the non MPS group, the admission BI score was 3.2 which improved to 9.6 at 3 month follow-up. In patients with complete paraplegia, evidence of denervation on EMG and unrecordable central motor conduction time to lower limb and tibial SEP were associated with poor outcome irrespective of MPS treatment. Global test statistics did not suggest a beneficial role of MPS therapy in the outcome of ATM.


CONCLUSIONS
Our results do not suggest a beneficial role of methyl prednisolone on the 3 month outcome of ATM.
Kalita
J
J
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, RaeBareli Road, Lucknow 226 014, India.
Misra
U K
UK
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000187:drug effects / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D013979:Tibial Nerve / Q000503:physiopathology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone