A Study Between Acute Transverse Myelitis And Spinal Forms Of Multiple Sclerosis

Objective: In this paper, we want to provide the scientific basis forcorrect selection of treatment options, predict the prognosis of disease andimprove the quality of life of the patients by differentiating acute transversemyelits （ATM）and spinal forms of multiple sclerosis（SMS). At the sametime, a follow-up in patients with acute transerve myelitis group is alsodeveloped to discover the proportion of acute transverse myelitis change intomultiple sclerosis.Methods:60patients with acute transverse myelitis and32patients withspinal forms of multiple sclerosis in the second hospital of HeBei MedicalUniversity between January2003and January2013were retrospectivelystudied.the diagnosis of ATM followed the diagnostic criteria of theTransverse Myelitis Consortium Working Group (2002):(1) development ofsensory, motor,or autonomic dysfunction attributable to the spinal cord;(2)bilateral signs and/or symptoms(though not necessarily symmetric);(3)clearlydefined sensory level;(4)exclusion of extra-axial compressive etiology byneuroimaging(5)Inflammation with the spinal cord demonstrated by CSFpleocytosis or elevated IgG index or gadolinium enhancement;(6)progressionto nadir between4h and21d following the onset of symptoms.Diagnosis ofSMS was based on poser criteria.Phoned all patients with ATM and record itsprognosis.We compared the baseline characteristics of the eligible patients in thetwo groups, including gender distribution, mean age, related inducements,spinal shock, complete paralysis of lower extremities, dysfunction of urinaryand defecation, sensory level, the onset to hospital time, symmetricalmyasthenia, involvement of segments of spinal cord on MRI, lesionssegments of vertebrals＞3, the protein and cells counting of CSF. Phoned all patients with ATM, recorded their prognosis at the same time.All data were analyzed with the aid of SPSS13.0. P<0.05(2-tailed) wasconsidered statistically significant.Results: A total of60eligible ATM patients (male25and female35,male: female=1:1.4) and32eligible SMS patients (male9and female23,male: female=1:2.5) were enrolled into this study. There were no significantdifferences between the two groups in baseline characteristics, includinggender distribution and mean age (both P>0.05). Before the diseases onset,there were21patients (35%) with inducements in ATM group and8patients(25%) with inducements in SMS group. There was no significant statisticaldifference between the two groups (P>0.05). In ATM group, theonset-to-hospital time is between0.17to120days (P50=3.0, P95=15.0), whilein SMS group, the onset-to-hospital time is between1to120days (P50=27.5,P95=120). There was a significant statistical difference between the twogroups (P<0.01). In ATM group, there were55patients (91.7%) withurination and defecation dysfunction, and some patients had to urinate withthe aid of indwelling catheter. However, there were12patients (37.5%) withurination and defecation dysfunction, and no one needed urinary catheter.There was significantly statistical different between the two groups (P<0.01).The incidence of spinal shock is33.3%(20/60) in ATM group, while0%inSMS group (P<0.01). The incidence of complete paralysis of lower limbs inATM group and SMS group is38.3%(23/60) vs.3.1%(1/32)(P<0.01). InATM group, there were55patients (91.6%) with sensory level, while8patients (25%) in SMS group (P<0.01). The incidence of symmetricalmyasthenia is67.8%(40/60) in ATM group, while28.6%(8/32) in SMSgroup (P<0.01). There were43(43/60) patients received lumbar puncture totest cerebrospinal fluid in ATM group, while17patients (17/32) in SMSgroup. The laboratory reports of the ATM group and SMS group were asfollows: leukocyte is higher than normal (14%(6/43) vs.11.8(2/17)) andprotein is higher than normal (27.9%(12/43) vs.17.6(3/17))(both P>0.05).There were58patients received MRI examination in ATM group and53 patients with abnormity including cervical spinal cord (12cases,22.6%),thoracic spinal cord (17cases,32.1%), cervical and thoracic spinal cord (19cases,35.8%), thoracic and lumbar spinal cord (3cases,5.7%), lumbarspinal cord (2cases,3.8%). While in SMS group, there were32patientsreceived MRI examination and all patients with abnormity including cervicalspinal cord (19cases,65.5%), thoracic spinal cord (2cases,23.2%), cervicaland thoracic spinal cord (8cases,32.9%). There were significant statisticaldifferences between the two groups (P<0.01). The respective incidences ofspinal cord swelling and Visual evoked potential (VEP) abnormity in ATMgroup and SMS group were34.5%(20/6) vs.17.2%(5/32),22.2%(4/18)vs.46.2%(6/13)(both P>0.05). There were45patients (77.6%) with lesionsegments of vertebral＞3in ATM group, while12patients (41.2%) in SMSgroup (P<0.01).There were26patients (26/60) received telephone follow-upabout9months to6years in ATM group. The results are as follows:3casesdied,17cases (73.9%) manifested unidirectional disease course,2cases(8.7%) turned into SMS which were diagnosed respectively at4months and3years,4cases (17.4%) suffered from ATM again (1twice and3once) and therecurrence time was from2months to1year. No one evolved into NeuroMyelitis Opica(NMO). One of patients had transient diplopia, but thesymptom changed better without recurrence.4out of17cases whomanifested unidirectional disease course were with myodynamia of the lowerextremities between grade0to grade1. Besides, they suffered fromdisappearing feeling of lower limbs, amyotrophy, urination and defecationdysfunction, long-term bed. One of them suffered from severe bedsore andanother one with renal function failure due to long-term urination dysfunction.14cases had dyskinesia of varying degrees, sensory abnormality, urinationand defecation dysfunction and sexual dysfunction. Dyskinesia manifestedunilateral or bilateral limb weakness, non ambulate and part of them had towalk with the aid of auxiliary tool. Sensory abnormality included: the feelingof cool, numbness and swelling, pain, foreign body sensation and so on, andsome patients suffered from more severe symptoms on bad weather. urination and defecation dysfunction manifested frequent micturition, the urgency ofurination, faint of micturition and defecation.2cases appeared discontinuitylower extremity twitch.Conclusion: Acute transverse myelitis and spinal forms of multiplesclerosis have many similarities on clinic manifestations, laboratory tests andimaging findings. There are some symptoms in favor of acute transversemyelitis, namely acute onset, urination and defecation dysfunction, spinalshock, complete paralysis of lower limbs, symmetrical myasthenia, sensorylevel, lesion segments of vertebral＞3, lesions affecting thoracic spinalcord.Most acute transverse myelitis patients manifest unidirectional diseasecourse and few of them will turn into spinal forms of multiple sclerosis.