Sevim Şahin, Gülen Gül Mert, Muhittin Bodur, Pınar Özkan Kart, Özlem Hergüner, İbrahim Öncel, Hasan Tekgül, Deniz Yüksel, Nihal Olgaç Dündar, Aycan Ünalp, Edibe Pembegül Yıldız, Mesut Güngör, Meltem Çobanoğulları Direk, İlknur Erol, Hüseyin Tan, Habibe Koç, Ayşe Tosun, A. Derda Yücel Şen, Banu Anlar, Turkish Pediatric Transverse Myelitis Study Group .

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

Sevim Şahin
Karadeniz Technical University Faculty of Medicine
Turkey

Gülen Gül Mert
Cukurova University Faculty of Medicine
Turkey

Muhittin Bodur
Uludağ University Faculty of Medicine
Turkey

Pınar Özkan Kart
Karadeniz Technical University Faculty of Medicine
Turkey

Özlem Hergüner
Cukurova University Faculty of Medicine
Turkey

İbrahim Öncel
Hacettepe University Faculty of Medicine
Turkey

Hasan Tekgül
Ege University Faculty of Medicine
Turkey

Deniz Yüksel
University of Health Sciences Turkey, Dr. Sami Ulus Research and Training Hospital
Turkey