Wise Young
07-29-2005, 04:14 AM
One question that many people have when they have been diagnosed to have TM is whether or not it will develop into multiple sclerosis (MS) or other kinds of recurrent neurological problem. The authors examined the histories of 30 patients with acute partial transverse myelitis (APTM) as opposed to severe or complete transverse myelitis) with normal brain MRI (ruling out MS at the beginning). Over 61 months, only 10% of the PTM patients progressed to definite MS. What is of greater interest are the following findings on the patients.
1. 46.6% of the patients had "relapses". This seems to have a very high incidence of relapses, suggesting a continuing cause, perhaps due to an autoimmune disease such as lupus.
2. 62% of the patients had oligodclonal bands, indicative of antibodies in the cerebrospinal fluid, suggestive of autoimmune disease, although only one of these progressed to clinically definite MS.
3. 27% had multifocal lesions of the spinal cord, again a higher incidence than expected from simple transverse myelitis. Interesting, 10% of the patients had no MRI changes.
These suggest that people who have acute partial transverse myelitis are different from severe TM.
Wise.
Scott TF, Kassab SL and Singh S (2005). Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically definite multiple sclerosis. Mult Scler 11: 373-7. OBJECTIVE: To determine the long-term risk of developing clinically definite multiple sclerosis (CDMS) in patients with acute partial transverse myelitis (APTM) and normal cerebral magnetic resonance imaging (MRI) scans. METHODS: We retrospectively studied 30 consecutive patients with clinical evidence of APTM. Patients with symmetric severe acute transverse myelitis were considered to have complete transverse myelitis and were excluded. All patients underwent spinal and cerebral MRIs, 13 underwent cerebrospinal fluid analysis and 11 patients underwent evoked potential studies. Various other studies were performed to assess for connective tissue disease and causes of APTM other than demyelinating disease. RESULTS: After an average follow-up of 61 months, all laboratory and clinical evidence, including relapse history, indicated that three patients developed lesions on cerebral MRI and could be classified as CDMS by either Poser criteria (two patients) or MacDonald criteria (one patient). Relapses limited to the spinal cord seen clinically were seen in 14/30 (46.6%) patients. Oligoclonal bands were seen in 8/13 (62%) patients; one patient transitioned to CDMS. Unifocal lesions of the cord were seen in 19/30 (63%) patients, multifocal lesions were seen in 8/30 (27%) and 3/30 (10%) had negative MRIs. The three patients who converted to CDMS did so within five years of the onset of myelitis. CONCLUSION: APTM with normal cerebral MRI had a low rate of conversion to CDMS in this long-term study. To date, there have been only a few follow-up studies that have addressed this issue. Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA. tscott@wpahs.org http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16042216
1. 46.6% of the patients had "relapses". This seems to have a very high incidence of relapses, suggesting a continuing cause, perhaps due to an autoimmune disease such as lupus.
2. 62% of the patients had oligodclonal bands, indicative of antibodies in the cerebrospinal fluid, suggestive of autoimmune disease, although only one of these progressed to clinically definite MS.
3. 27% had multifocal lesions of the spinal cord, again a higher incidence than expected from simple transverse myelitis. Interesting, 10% of the patients had no MRI changes.
These suggest that people who have acute partial transverse myelitis are different from severe TM.
Wise.
Scott TF, Kassab SL and Singh S (2005). Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically definite multiple sclerosis. Mult Scler 11: 373-7. OBJECTIVE: To determine the long-term risk of developing clinically definite multiple sclerosis (CDMS) in patients with acute partial transverse myelitis (APTM) and normal cerebral magnetic resonance imaging (MRI) scans. METHODS: We retrospectively studied 30 consecutive patients with clinical evidence of APTM. Patients with symmetric severe acute transverse myelitis were considered to have complete transverse myelitis and were excluded. All patients underwent spinal and cerebral MRIs, 13 underwent cerebrospinal fluid analysis and 11 patients underwent evoked potential studies. Various other studies were performed to assess for connective tissue disease and causes of APTM other than demyelinating disease. RESULTS: After an average follow-up of 61 months, all laboratory and clinical evidence, including relapse history, indicated that three patients developed lesions on cerebral MRI and could be classified as CDMS by either Poser criteria (two patients) or MacDonald criteria (one patient). Relapses limited to the spinal cord seen clinically were seen in 14/30 (46.6%) patients. Oligoclonal bands were seen in 8/13 (62%) patients; one patient transitioned to CDMS. Unifocal lesions of the cord were seen in 19/30 (63%) patients, multifocal lesions were seen in 8/30 (27%) and 3/30 (10%) had negative MRIs. The three patients who converted to CDMS did so within five years of the onset of myelitis. CONCLUSION: APTM with normal cerebral MRI had a low rate of conversion to CDMS in this long-term study. To date, there have been only a few follow-up studies that have addressed this issue. Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA. tscott@wpahs.org http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16042216