Peculiarities of transverse myelitis: retrospective institutional cohort study.

Authors

  • Oxana GROSU Institute of Neurology and Neurosurgery "Diomid Gherman"
  • Galina ZOLOTCO "Diomid Gherman" Institute of Neurology and Neurosurgery; "Nicolae Testemițanu" State University of Medicine and Pharmacy
  • Galina CORCEA Institute of Neurology and Neurosurgery "Diomid Gherman"
  • Elena MANOLE "Nicolae Testemitanu" State University of Medicine and Pharmacy

DOI:

https://doi.org/10.52692/1857-0011.2022.3-74.12

Keywords:

transverse myelitis, cohort study, autoimmune myelitis, antibodies

Abstract

Transverse myelitis (TM) is a clinical syndrome in which an inflammatory process causes neuronal damage to the spinal cord, leading to varying degrees of muscle weakness, sensory changes, and autonomic dysfunction. MT can be a form of presentation of a multi-focal CNS disease, multi-systemic, infectious, paraneoplastic, demyelinating, autoimmune or idiopathic disease.The purpose of the research was to analyze the cases of transverse myelitis codes in patients treated and hospitalized in the “Diomid Gherman” Institute of Neurology and Neurosurgery.Material and method: 22905 medical records of patients treated in the Institute of Neurology and Neurosurgery between February 2018 and April 2022 were analyzed, 53 patients diagnosed with transverse myelitis were selected and 44 records were eligible, analyzed and included in the study. Results: The average age of the subjects included in the research was 50.9±11.7 years, they were on treatment for an average of 11.2±8.04 days. Neurological manifestations were presented in 43 people. The clinical presentation included: sensitivity disorders (75%), sphincteric disorders (61.4%), limb paresthesia (40.9%), motility disorders (95.5%), fever (4.5%), depression (6.8%), headache (15.9%), back pain (15.9%). The most frequent investigations performed on patients in the study group was CT/MRI thoracic, cervical, lumbo-sacral, cerebral, EMG. Lumbar puncture was performed in 32 patients (72.7%) with CSF examination. Laboratory analyzes showed signs of inflammation - 54.5%, elevated blood sugar - 40.8%, dyslipidemia - 38.6% and anemia - 25%. Corticosteroid treatment was performed in 25 subjects (56.8%) with improvement in most cases (80%). Frequent complications were urinary infection (52.3%), pneumonia (9.1%), 2 deaths (4.5%). Conclusion: The analysis of the institutional cohort of patients with transverse myelitis confirmed that the diagnosis of MT continues to present a challenge and requires a complex approach, correct both clinical and paraclinical.

Author Biographies

Oxana GROSU, Institute of Neurology and Neurosurgery "Diomid Gherman"

dr. șt. med.,cercet. șt,

Galina ZOLOTCO, "Diomid Gherman" Institute of Neurology and Neurosurgery; "Nicolae Testemițanu" State University of Medicine and Pharmacy

medic rezident, cercet. șt. stag.,;Catedra Neurologie 1

Galina CORCEA, Institute of Neurology and Neurosurgery "Diomid Gherman"

dr. șt. med.,cercet. șt.,

Elena MANOLE, "Nicolae Testemitanu" State University of Medicine and Pharmacy

dr. șt. med, conf.univ.;Catedra Neurologie 1

References

Lim PAC. Transverse Myelitis. Essentials of Physical Medicine and Rehabilitation. 2020:952–9. doi: 10.1016/B978-0-323-54947-9.00162-0. Epub 2019 Apr 17. PMCID: PMC7151963.

Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59(4):499505doi. org/10.1212/WNL.59.4.499

Beh SC, Greenberg BM, Frohman T, Frohman EM. Transverse myelitis. Neurol Clin. 2013 Feb;31(1):79-138. doi:10.1016/j.ncl.2012.09.008. PMID:23186897;PMCID: PMC7132741.

JustinR. Abbatemarco, Jonathan R. Galli, Michael L. Sweeney, Modern Look at Transverse Myelitis and Inflammatory Myelopathy Epidemiology of the National Veterans Health AdministrationPopulation Neurol Neuroimmunol Neuroinflamm Nov2021, 8 (6) e1071; DOI: 10.1212/NXI.0000000000001071.

Scott, T.F., Frohman, E.M., MD, PhD, De Seze, J., Gronseth, G.S., MD, FAAN, et al. (2011). Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis: Report of the Therapeutics and Technology Assessment Subcommittee of the AmericanAcademyofNeurology. Neurology, 77,.doi.org/10.1212/WNL.0b013e31823dc535

Krishnan, C., Kaplin, A.I., Pardo,C.A. et al. Demyelinating disorders: Update on transverse myelitis. Curr Neurol Neurosci Rep 6, 236–243 (2006). doi.org/10.1007/s11910-006-0011-1

Greenberg, Benjamin & MD, MHS. (2011). Treatment of Acute Transverse Myelitis and ItsEarlyComplications. CONTINUUM: Lifelong Learning in Neurology, 17,733743. doi.org/10.1212/01.CON.0000403792.36161.f5.

Elliot M. Frohman, M.D., Ph.D., and Dean M. Wingerchuk, M.D Transverse Myelitis August 5, 2010N Engl J Med 2010; 363:564-572DOI: 10.1056/NEJMcp1001112

Valiuddin H, Skwirsk B, Paz-Arabo P. Acute transverse myelitis associated with SARS-CoV-2: A Case-Report. Brain Behav Immun Health. 2020 May;5:100091. doi:10.1016/j.bbih.2020.100091. Epub 2020 Jun 6. Erratum in: Brain Behav Immun Health. 2021 Dec 23; 19:100408.PMID:32835294; PMCID:PMC7275168.

Cobo Calvo, Á., Mañé Martínez, M.A., Alentorn-Palau, A. et al. Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol 13, 135 (2013). doi.org/10.1186/1471-2377-13-135.

Wingerchuk,Dean,MD,MSc,Weinshenker,Brian&MD,FRCP.(2013). Acute Disseminated Encephalomyelitis, Transverse Myelitis, and Neuromyelitis Optica. CONTINUUM: Lifelong Learning in Neurology, 19,944-967. doi.org/10.1212/01.CON.0000433289.38339.a2.

Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59(4):499-505.doi. org/10.1212/WNL.59.4.499

Lopez Chiriboga, Sebastian & Flanagan, Eoin. (2021). Myelitis and Other Autoimmune Myelopathies. CONTINUUM: Lifelong Learning in Neurology, 27,62doi. org/10.1212/CON.0000000000000900

Eva C. Schulte, Larissa Hauer, Alexander B. Kunz, Johann Sellner Systematic review of cases of acute myelitis in individuals with COVID doi.org/10.1111/ene.14952Volume 28, Issue 10Special Issue: COVID-19 October2021.

Simone CG, Emmady PD. Transverse Myelitis. [Updated 2022 Jun 10]. www.ncbi.nlm.nih.gov/books/NBK559302.

Peter A.C. Lim, Chapter 162 Transverse Myelitis, Essentials of Physical Medicine and Rehabilitation (Fourth Edition), Elsevier, 2020,Pages 952-959, doi.org/10.1016/ B978-0-323-54947-9.00162-0.

Shin C. Beh, Benjamin M. Greenberg, Teresa Frohman, Elliot M. Frohman, Transverse Myelitis, Neurologic Clinics,Volume 31, Issue 1, 2013, Pages 79-138,doi. org/10.1016/j.ncl.2012.09.

Published

2022-12-12

Issue

Section

Research Article

Categories