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Evaluation of Prognostic Factors in Pediatric Transverse Myelitis: A Multicenter Cohort Study

Objective: Acute transverse myelitis (ATM) may cause severe disability, limiting daily living skills, in children. In this multicenter study, we aimed to determine the prognostic factors in pediatric ATM. Methods: Data from 193 individuals (99 boys, 94 girls) with their first episode of ATM who presented between 2010-2021 were collected from 27 centers. Cases with a previous diagnosis of demyelinating disease, spinal tumors, or vascular origin were excluded from the cohort. Data from the entire cohort, and etiologic subgroups with Rankin scores (RS) at last follow-up ≥ 3 (HRS) and < 3 (LRS), were statistically compared in terms of clinical and immunologic parameters, and treatment modalities (plasmapheresis, IVMP, and IVIG). Results: The median age at presentation and follow-up time were 8.9-years, and 18-months, respectively. The etiological causes were idiopathic (73.6%), demyelinating (21.2%), and infectious diseases (4.1%). The HRS group had statistically significant six clinical and immunologic parameters for an unfavorable outcome; higher RS at admission (p<0.003), increased neutrophil-lymphocyte ratio (NLR) (p=0.013), higher rate of seropositivity of a recent infection (p=0.018), high rate of CMV IgM positivity (p=0.012), lower lymphocyte count (p=0.01) and a higher prevalence of hypoactivity of deep tendon reflexes (DTR) on admission (p=0.028) (Table1). However, the rate of patients given intravenous methylprednisolone (IVMP) as initial treatment was lower (p=0.024) in the HRS group. Conclusion: Certain immunologic parameters (increased NLR and lower lymphocyte count) might be considered unfavorable outcome parameters for children with ATM. Early IVMP treatment is the main clinical parameter for the favorable outcome in pediatric ATM.
Keywords: child, neutrophil to lymphocyte ratio, Rankin score, transverse myelitis