Demyelinating disorders: update on transverse myelitis.
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.
Krishnan
Chitra
C
Department of Neurology, Johns Hopkins University School of Medicine, Pathology 627, 600 North Wolfe Street, Baltimore, MD 21287-6965, USA.
Kaplin
Adam I
AI
Pardo
Carlos A
CA
Kerr
Douglas A
DA
Keswani
Sanjay C
SC
D015415:Biomarkers / Q000378:metabolism; D002986:Clinical Trials as Topic; D003711:Demyelinating Diseases / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009188:Myelitis, Transverse / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D018696:Neuroprotective Agents / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use
D015415:Biomarkers; D018696:Neuroprotective Agents; D013256:Steroids