NMO-IgG-negative relapsing myelitis

S. Ravaglia, S. Bastianello, D. Franciotta, M. Ceroni, A. Pichiecchio, E. Tavazzi, A. Moglia, E. Marchioni

Research output: Contribution to journalArticle

Abstract

Objective:Idiopathic transverse myelitis (I-TM) is typically monophasic, while relapsing forms are usually referred to spinal cord-restricted neuromyelitis optica (NMO), atypical multiple sclerosis (MS), or myelitis during the course of infections and connectivitis. Our objective was to evaluate the frequency of recurrent I-TM; to clarify the nosology of these forms through comparison with NMO and post-infectious TM (P-TM).Design:Prospective cohort study on patients presenting with I-TM was carried out inpatients of Infectious and Neurologic Disease Clinics, Italy.Methods:Over an 8-year period, we recruited 13 patients with I-TM and 16 with P-TM. The patients were followed-up for at least 3 years with repeated brain and spinal cord magnetic resonance imaging (MRI) examinations, multimodal evoked potentials and serum screen for connectivitis. Relapses were defined on clinical and imaging criteria.Results:Four patients with I-TM (31%) had a relapsing course. They were all males with age 50, and severe at-onset disability. The final outcome was poor in three out of four patients. Serum NMO-immunoglobulin G was undetectable in all patients. Longitudinally extensive myelitis was not predictive of relapses. I-TM and P-TM shared clinical, cerebrospinal fluid (CSF) and MRI features, as well as a similar rate (54 vs 38%) of peripheral nervous system involvement (polyradiculoneuritis), and an identical rate of relapses (31% for both forms).Conclusions:Our series support the existence of relapsing I-TM as a disease entity that does not appear related to NMO, nor to MS, cannot be further specified and shares many features with P-TM. The likelihood of relapses was unpredictable based on clinical, CSF and MRI findings.

Original languageEnglish
Pages (from-to)531-537
Number of pages7
JournalSpinal Cord
Volume47
Issue number7
DOIs
Publication statusPublished - Jul 2009

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Keywords

  • ADEM
  • Neuromyelitis optica
  • NMO-IgG
  • Relapsing myelitis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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