Assessment of outcome predictors in first-episode acute myelitis: a retrospective study of 53 cases.
OBJECTIVE
To identify predictors of short- and long-term outcomes in acute myelitis (AM).


METHODS
First episodes of AM were retrospectively identified in a single institution. Information regarding demographics, clinical status, laboratory workup, magnetic resonance imaging of the spine and brain, and electrophysiological assessment was collected. Tau, 14-3-3 protein, and cystatin C levels were assessed de novo in stored cerebrospinal fluid samples.


METHODS
A neurological department database. Patients Fifty-three patients with a first episode of AM.


METHODS
The prognostic value of all variables was analyzed for the following outcomes: recovery from the initial event, symptom recurrence, conversion to multiple sclerosis (MS), and long-term disability.


RESULTS
Median follow-up was 6.2 years. Six patients (11%) remained monophasic; 5 (9%) developed recurrent myelitis; and 42 (79%) underwent conversion to MS. Sensory level absence, no sphincter involvement, abnormal magnetic resonance imaging findings in the brain, spinal cord lesions shorter than 3 vertebral segments, and abnormal somatosensory evoked potentials predicted MS conversion. Fifteen of 32 patients with pyramidal dysfunction at onset (47%) and 17 of 43 with relapses during follow-up (40%) had significant disability at the last visit compared with 2 of 21 patients without pyramidal manifestations (10%) and none of the patients without exacerbations (P = .006 and P = .02, respectively). In 11 patients with exacerbations, we observed a significant correlation between cerebrospinal fluid levels of cystatin C and the degree of neurological disability at the last visit (Spearman rho = 0.69; P = .03).


CONCLUSIONS
For patients with first-episode AM, the conversion rate to MS is high. Motor dysfunction at onset and relapse occurrence are associated with worse outcome. Cerebrospinal fluid levels of cystatin C may prove useful for predicting the prognosis of such patients.
Gajofatto
Alberto
A
Section of Clinical Neurology, Department of Neurological and Vision Sciences, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy. alberto.gajofatto@univr.it
Monaco
Salvatore
S
Fiorini
Michele
M
Zanusso
Gianluigi
G
Vedovello
Marcella
M
Rossi
Francesca
F
Turatti
Marco
M
Benedetti
Maria Donata
MD
D048948:14-3-3 Proteins / Q000134:cerebrospinal fluid; D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D055316:Cystatin C / Q000134:cerebrospinal fluid; D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D018450:Disease Progression; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology*; D009187:Myelitis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000473:pathology; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D048948:14-3-3 Proteins; D055316:Cystatin C; D043025:Oligoclonal Bands