Medline ® Abstract for Reference 68
of 'Transverse myelitis'
Assessment of outcome predictors in first-episode acute myelitis: a retrospective study of 53 cases.
Gajofatto A, Monaco S, Fiorini M, Zanusso G, Vedovello M, Rossi F, Turatti M, Benedetti MD
Arch Neurol. 2010;67(6):724.
OBJECTIVE: To identify predictors of short- and long-term outcomes in acute myelitis (AM).
DESIGN: First episodes of AM were retrospectively identified in a single institution. Information regarding demographics, clinical status, laboratory workup, magnetic resonance imaging of the spine and brain, and electrophysiological assessment was collected. Tau, 14-3-3 protein, and cystatin C levels were assessed de novo in stored cerebrospinal fluid samples.
SETTING: A neurological department database. Patients Fifty-three patients with a first episode of AM.
MAIN OUTCOME MEASURES: The prognostic value of all variables was analyzed for the following outcomes: recovery from the initial event, symptom recurrence, conversion to multiple sclerosis (MS), and long-term disability.
RESULTS: Median follow-up was 6.2 years. Six patients (11%) remained monophasic; 5 (9%) developed recurrent myelitis; and 42 (79%) underwent conversion to MS. Sensory level absence, no sphincter involvement, abnormal magnetic resonance imaging findings in the brain, spinal cord lesions shorter than 3 vertebral segments, and abnormal somatosensory evoked potentials predicted MS conversion. Fifteen of 32 patients with pyramidal dysfunction at onset (47%) and 17 of 43 with relapses during follow-up (40%) had significant disability at the last visit compared with 2 of 21 patients without pyramidal manifestations (10%) and none of the patients without exacerbations (P = .006 and P = .02, respectively). In 11 patients with exacerbations, we observed a significant correlation between cerebrospinal fluid levels of cystatin C and the degree of neurological disability at the last visit (Spearman rho = 0.69; P = .03).
CONCLUSIONS: For patients with first-episode AM, the conversion rate to MS is high. Motor dysfunction at onset and relapse occurrence are associated with worse outcome. Cerebrospinal fluid levels of cystatin C may prove useful for predicting the prognosis of such patients.
Section of Clinical Neurology, Department of Neurological and Vision Sciences, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy. email@example.com