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Abstract Details

Acute Inflammatory Myelitis: a pragmatic approach
Autoimmune Neurology
P10 - Poster Session 10 (5:30 PM-6:30 PM)
15-004

To determine which clinical and paraclinical features best contribute to autoimmune acute transverse myelitis (ATM) diagnosis.

Confirming ATM diagnosis can be challenging for neurologists. 

Due to the importance of prompt, etiology-oriented treatment and the varying prognosis resulting from different etiologies, choice of tests and procedures needed to establish diagnosis are key.

Medical records of adult patients developing ATM according to Transverse Myelitis Consortium Working Group diagnostic criteria treated at our center between June/2000 and August/2019 were reviewed. 

After excluding cases of infectious, metabolic, ischemic or compressive origin, patient demographics, clinical presentation, disease course and ancillary tests were examined.

We identified 172 patients, with the following diagnoses: 68 cases of Multiple Sclerosis (MS), 16 Neuromyelitis Optica Spectrum Disorders (NMOSD), 44 Idiopathic myelitis (IM), 23 Recurrent Myelitis (RM) and 21 with Systemic antibodies associated-myelitis (SAb-M).  

Univariate multinomial logistic regression analysis, with IM as reference showed variables increasing risk of developing MS included: oligoclonal band presence (OCB) (3.65,p=0.01),  multisegmental myelitis (OR 1.88,p=0.01) and presence of demyelinating brain lesions (OR=64.7,p<0.001). However, a higher modified Rankin scale (mRS) at admission decreased the risk to develop MS (OR 0.62,p=0.01). 

Variables which increased NMOSD risk were: antinuclear antibodies (ANA) titers over 1/80 (OR=5.20,p=0.04), longitudinally extended lesions (OR=27,p=0.003) and demyelinating brain lesions (OR=10,p=0.01).

Elevated ANA titers (>1/80) were the only parameter associated with increased risk of SAb-M (OR=26.5,p<0.001).

Multivariate multinomial logistic regression analysis indicated recurrence significantly increased risk of both MS and NMOSD (OR=6.47,p=0,04; OR=8.7,p=0.05). 

Longitudinally extended lesions showed positive correlation with NMOSD diagnosis (OR=16,24,p=0,01), and negative correlation with MS (OR=0,18,p=0,01). Presence of typical demyelinating brain lesions suggested diagnosis of MS (OR=28.6,p<0,001).
Presence of typical MS brain lesions, positive OCB, SAb-M positivity, recurrence, values of mRS at admission, and extension of spinal cord lesions were found to be factors contributing to correct etiological diagnosis of ATM.
Authors/Disclosures
Micaela Hernandez, MD (FLENI)
PRESENTER 		Dr. Hernandez has nothing to disclose.
Mariano Marrodan, MD (Institute for Neurological Research Raul Carrea. Fleni) Dr. Marrodan has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Marrodan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck, Astra Zeneca, Gador, Biogen, Roche and Novartis.
Alejandro Kohler No disclosure on file
Jorge D. Correale, MD (Institute for Neurological Research) Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ROche. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Correale has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Correale has received research support from Merck. The institution of Dr. Correale has received research support from Biogen. The institution of Dr. Correale has received research support from Novartis .