title: Acute transverse myelitis in childhood: A single centre experience from North India.
abstract: BACKGROUND
  Acute transvers myelitis (ATM) is a rare and disabling condition in childhood. There are only few reports of clinical profile, prognosis and predictors of ATM from developing countries.
  
  
  OBJECTIVE
  To study the clinical profile of children with ATM and predictors of its outcome.
  
  
  METHODS
  Retrospective analysis of children <12 years of age diagnosed with ATM over a period of 6 years from a tertiary care institute.
  
  
  RESULTS
  Thirty six children (21 boys, median age-7.5 years) were diagnosed with ATM. Weakness was symmetrical at onset in 27 (75%) children with progression over a median of 2 days (IQR 1-5 days). Severe weakness at onset with lower limb power ≤ 1/5 on MRC scale was present in 27 (75%), a sensory level in 25(69.4%) and bladder dysfunction in 31(86.1%) children. MRI showed longitudinal extensive myelitis (LETM) in 27 (75%) children and the thoracic cord was most commonly affected [18 (50%)]. On a median follow up of 35 months (range IQR 11-57 months); 15 (41.7%) were non ambulatory or required assistance to walk. Severe weakness at onset with power ≤ 1 on MRC scale, spinal shock, respiratory muscle weakness, mechanical ventilation, greater mean time to diagnosis and treatment was associated with bad outcome. ATM was a monophasic illness in all, except in 3 children; all with neuromyelitis optica spectrum disorder. Progression to multiple sclerosis was not seen in any child in our cohort.
  
  
  CONCLUSIONS
  In this series of childhood ATM from North India, the disease was severe, monophasic and involved long segments (≥ 3) of cord in majority. Nearly half the children remain dependent on follow up. Delayed diagnosis and delayed initiation of steroid therapy was associated with poor outcome.
authors.affiliation: Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: drrenusuthar@gmail.com.
authors.forename: Renu
authors.initials: R
authors.lastname: Suthar
authors.affiliation: Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: drnsankhyan@yahoo.co.in.
authors.forename: Naveen
authors.initials: N
authors.lastname: Sankhyan
authors.affiliation: Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: Jsh2003@gmail.com.
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Sahu
authors.affiliation: Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: khandelwaln@hotmail.com.
authors.forename: Niranjan K
authors.initials: NK
authors.lastname: Khandelwal
authors.affiliation: Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: sunit.singhi@gmail.com.
authors.forename: Sunit
authors.initials: S
authors.lastname: Singhi
authors.affiliation: Unit of Pediatric Neurology and Neurodevelopment, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: doctorpratibhasinghi@gmail.com.
authors.forename: Pratibha
authors.initials: P
authors.lastname: Singhi
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009188:Myelitis, Transverse / Q000175:diagnosis* / Q000473:pathology; D009471:Neuromyelitis Optica / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies
keywords: Acute transvers myelitis (ATM); Children; Longitudinal extensive transverse myelitis (LETM); Neuromyelitis optica spectrum disorders (NMODS); Outcome