Inflammatory transverse myelitis: evolving concepts.
OBJECTIVE
Acute transverse myelitis is a pathogenetically heterogeneous inflammatory disorder of the spinal cord. Here we describe recent advances in inflammatory non-infectious transverse myelitis. Particular attention will be paid to the serum autoantibody marker NMO-IgG and its application to acute transverse myelitis.


RESULTS
The recent identification of neuromyelitis optica-IgG, a novel marker of neuromyelitis optica spectrum disorders (including longitudinally extensive transverse myelitis), contributes to an evolving understanding of acute transverse myelitis. Other serological markers, such as collapsin response-mediator protein-5 -IgG and amphiphysin-IgG, predict specific cancers in the setting of a paraneoplastic acute transverse myelitis. Furthermore, novel inflammatory markers such as interleukin-6 or other proteins in their signaling pathways may represent markers of disease severity and potential therapeutic targets. Additional cerebrospinal fluid biomarkers, such as protein 14-3-3 and neuron-specific enolase, may be useful prognostic indicators in transverse myelitis. Acute transverse myelitis in children, in contrast to adults, is more likely to be longitudinally extensive, and has a better prognosis and lower likelihood of recurrence. Prognostic factors in pediatric transverse myelitis are reviewed.


CONCLUSIONS
The recent identification of novel biomarkers associated with acute transverse myelitis has led to a better understanding of the spectrum of disorders associated with inflammatory transverse myelitis, as well as a greater appreciation of its diverse and complex pathogenetic basis.
Pittock
Sean J
SJ
Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. Pittock.sean@mayo.edu
Lucchinetti
Claudia F
CF
D020346:Aquaporins / Q000502:physiology; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000276:immunology / Q000473:pathology; D015415:Biomarkers; D002648:Child; D006801:Humans; D009188:Myelitis, Transverse / Q000276:immunology / Q000473:pathology*; D020364:Paraneoplastic Polyneuropathy / Q000276:immunology / Q000473:pathology
D020346:Aquaporins; D001323:Autoantibodies; D015415:Biomarkers