Acute transverse myelitis in children: clinical course and prognostic factors.
The objective of this study was to describe the clinical course of acute transverse myelitis in children, to identify prognostic factors, and to compare our findings with published data Twenty-four children, aged 2 to 14 years and admitted with a diagnosis of acute transverse myelitis, were studied. Clinical features and results of investigations were collected at admission and during the course of the disease. Motor, sphincter, and global outcomes were compared with those in the main adult and pediatric series. During the initial phase, the most common presenting symptoms were pain (88%) and fever (58%). Motor loss preceded sphincter dysfunction in two thirds of patients and became bilateral in half of the patients. When maximal deficit was achieved (plateau), the patients presented a combination of sensory, motor, and sphincter dysfunctions without radicular involvement The motor loss consistently involved the lower limbs but was inconsistent and moderate in the upper limbs. The mean duration of the plateau was 1 week. The recovery phase was characterized by a progressive improvement of all deficits. Sphincter dysfunction improved more slowly than did the other deficits. A full recovery was achieved by 31% of the patients; minimal sequelae were present in 25% and mild to severe sequelae in 44%. An unfavorable outcome was associated with complete paraplegia (P = .03) and/or a time to maximal deficit shorter than 24 hours (P = .005). A favorable outcome was associated with a plateau shorter than 8 days (P = .03), the presence of supraspinal symptoms (P = .01), and a time to independent walking shorter than 1 month (P = .01). The course of acute transverse myelitis in children proceeds through three stages, an initial phase, a plateau, and a recovery phase, each characterized by specific clinical features. The global outcome was favorable in 56% of patients. Several prognostic factors were identified.
Defresne
Pierre
P
Service de Neurologie, Département de Pédiatrie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium. pierre.defresne@nepe.ucl.ac.be
Hollenberg
Henri
H
Husson
Béatrice
B
Tabarki
Brahim
B
Landrieu
Pierre
P
Huault
Gilbert
G
Tardieu
Marc
M
Sébire
Guillaume
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors