Prognostic factors for relapse and outcome in pediatric acute transverse myelitis
Helfferich, Jelte; Bruijstens, Arlette L.; Wong, Yu Yi M.; Danielle van Pelt, E.; Boon, Maartje; Neuteboom, Rinze F.; Bakker, D. P.; Braun, K. P.J.; van Dijk, K. G.J.; Eikelenboom, M. J.; Engelen, M.; Brandsma, R.; Haaxma, C. A.; Niermeijer, J. M.F.; Niks, E. H.; Peeters, E. A.J.; Peeters-Scholte, C. M.P.C.D.; Portier, R. P.; de Rijk-van Andel, J. F.; Samijn, J. P.A.; Schippers, H. M.; Sie, L. T.L.; Snoeck, I. N.; Vermeulen, R. J.; Verrips, A.; Visscher, F.; Willemsen, M. A.A.P.; Catsman-Berrevoets, C. E.
(2021) Brain and Development, volume 43, issue 5, pp. 626 - 636
(Article)
Abstract
Objective: It may be difficult for clinicians to estimate the prognosis of pediatric acute transverse myelitis (ATM). The aim of this study was to define prognostic factors for relapsing disease and poor outcome in pediatric ATM. Methods: This prospective cohort study included 49 children, 18 boys and 31 girls (median
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age 13.1 years, IQR 6.5–16.2) with a first episode of ATM. Factors associated with relapsing disease and poor outcome (Expanded Disability Status Scale (EDSS) ≥ 4) were assessed during a median follow-up of 37 months (IQR 18–75). Results: In total, 14 patients (29%) experienced ≥ 1 relapse(s) and nine patients (18%) had a poor outcome. Factors at onset associated with relapsing disease included higher age (16.1 vs. 11.6 years, p = 0.002), longer time to maximum severity of symptoms (5.5 vs. 3 days, p = 0.01), lower maximum EDSS score (4.0 vs. 6.5, p = 0.003), short lesion on spinal MRI (64 vs. 21%, p = 0.006), abnormalities on brain MRI (93 vs. 44%, p = 0.002) and presence of oligoclonal bands in cerebrospinal fluid (67 vs. 14%, p = 0.004). The only factor associated with poor outcome was presence of a spinal cord lesion on MRI without cervical involvement (56 vs. 14%, p = 0.02). Conclusion: Pediatric ATM patients presenting with clinical, radiological and laboratory features associated with multiple sclerosis (MS) are at risk for relapsing disease. In absence of these known MS risk factors at onset of disease these patients are at low risk for relapses. Only a minority of pediatric ATM patients in this cohort have a poor outcome.
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Keywords: Acute transverse myelitis, Multiple sclerosis, Neuromyelitis optica spectrum disorders, Outcome, Pediatric, Relapsing disease, Pediatrics, Perinatology, and Child Health, Developmental Neuroscience, Clinical Neurology
ISSN: 0387-7604
Publisher: Elsevier
Note: Funding Information: This study was supported by the Dutch MS research Foundation. This study was not industry sponsored. Funding Information: We would like to express our gratitude to the late prof. dr. Rogier Hintzen (former head of our MS Center ErasMS and Dutch National Pediatric MS center, Erasmus MC, Rotterdam) who unexpectedly passed away recently. He was one of the founders of our nationwide study on acquired demyelinating syndromes in children (PROUD-kids study) and his driven creative mind will still be inspiring for our following research. We also would like to thank Wichor Bramer (biomedical information specialist) for his help with the literature search. Jelte Helfferich, Arlette L. Bruijstens, Yuyi M. Wong, E. Danielle van Pelt and Maartje Boon declare no competing interests. Rinze F. Neuteboom participates in trials by Sanofi and Novartis, and received honorarium from Novartis and Zogenix. This study was supported by the Dutch MS research Foundation. This study was not industry sponsored. Publisher Copyright: © 2020 The Japanese Society of Child Neurology
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