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Analysis of prognostic factors associated with longitudinally extensive transverse myelitis


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Title:
Analysis of prognostic factors associated with longitudinally extensive transverse myelitis
Authors:
Sepúlveda, María
Blanco, Yolanda
Saiz, Albert  
Gabilondo, Iñigo  
Villoslada, Ana  
Perez-Sempere, Angel  
Ramió-Torrentà, Lluís  
Olascoaga, Javier  
Montalban, Xavier  
Rovira, Alex
Rio, Jordi  
Mendibe , Mar  
Llufriu, Sara
Castilló, Joaquín  
Corral, Juan  
Ayuso, Teresa  
Cristina, Iñiguez  
Santos, Sonia
Guijarro, Cristina  
Graus, Francesc  
Editor:
SAGE Publications
Department:
Departamentos de la UMH::Medicina Clínica
Issue Date:
2012-10
URI:
https://hdl.handle.net/11000/30615
Abstract:
Abstract Objective: The aim of this study is to report the clinical profile and outcome of longitudinally extensive transverse myelitis (LETM). Methods: We prospectively studied adult patients who presented with LETM from January 2008 to December 2011. Information on demographic, clinical course, magnetic resonance imaging (MRI) and outcome was collected. HLA-DRB1 genotype was compared with those of 225 normal controls and patients with MS (228) and neuromyelitis optica (NMO) (22). Results: In total, 23 patients (16 female) with a median age of 44.5 years (range: 20–77 years) were included. Most (74%) had moderate–severe disability at nadir (48% non-ambulatory), normal/non-multiple sclerosis (MS) brain MRI (96%) and a median MRI cord lesion of 5 vertebral segments (range: 3–19). Laboratory analysis showed cerebrospinal fluid pleocytosis (45%), NMO-IgG (9%), antinuclear antibodies (70%), and genotype HLA-DRB1*13 (57%). The frequency of DRB1*13 genotype was higher compared with controls (p=0.002), MS (p=0.001) and NMO (p= 0.003) patients. After a median follow-up of 32 months, one patient converted to MS, two had relapsing LETM with NMO-IgG, and 20 remained as idiopathic with recurrences in four (20%). Twelve (52%) patients recovered with minimal disability (Expanded Disability Status Scale (EDSS) <2.5) and three (13%) remained wheelchair dependent. Disability at nadir was associated with the final outcome and extension of the spinal cord lesion with risk of recurrence. Recurrence was not associated with worse outcome. Conclusions: Inflammatory LETM is mostly idiopathic with a good outcome. It includes a relatively homogenous group of patients with an overrepresentation of the HLA-DRB1*13 genotype. EDSS at nadir is a predictor of the final outcome and extension of the myelitis of the recurrence risk.
Keywords/Subjects:
Transverse myelitis
multiple sclerosis
neuromyelitis optica
MRI
HLA
Knowledge area:
CDU: Ciencias aplicadas: Medicina
Type of document:
application/pdf
Access rights:
info:eu-repo/semantics/openAccess
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
DOI:
https://doi.org/10.1177/1352458512461968
Appears in Collections:
Artículos Medicina Clínica



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