Myelitis is a condition of the spinal cord that gather “all the electric cables” before they are distributed to the different organs.
Causes of disease
In most cases, transverse myelitis has an infectious origin (mycoplasma, EBV, CMV …). Sometimes, it can be caused by autoimmune diseases (cell dysfunction that would normally protect us and that turn against us). It can also be an inaugural sign of NMO syndrome or DEVIC disease and rarely, it can be associated with MS at onset.
If any other cause is found, it is called an Idiopathic transverse myelitis.
They occur in a brutal way: children can no longer walk or move. There are often associated with difficulties in urination and defecation (sphincter involvement), which indicate the severity of the disease.
Evidence of the disease
Spinal MRI imaging confirms the diagnosis by showing the presence of white spots in the spinal cord. Sometimes, when MRI is done too early, the spots may not be present at the beginning, but this does not eliminate the diagnosis. A lumbar puncture can also show irritation of the meninges. If cerebral MRI shows lesions, MS or other systemic diseases can be suspected. Anti-AQP4 antibodies may also be helpful.
One-third of children evolve favorably, 1/3 have severe sequelae and 1/3 have moderate sequelae. The most common sequelae are sensory disturbances and bladder dysfunction (15%–50%). Using Kidbiosep cohort and UK-CID cohort, we have demonstrated that female gender, a severe clinical score (ASIA score at onset), absence of pleiocytosis, absence of cervico thoracic lesions and gad enhancement on the spinal MRI were prognostic factors of bad outcome. Female gender and presence of brain lesion have been factors of relapse.
The reference treatment remains in acute period the cures of high doses of methyl prednisolone for 3 or 5 days depending on the severity of the disease. These treatments may optionally be repeated in function of the evolution. Sometimes immunoglobulins can be associated without having proved their effectiveness. Plasmapheresis can be added in severe cases.
Clinical rehabilitation is an extremely important aspect of this pathology. It can sometimes be long in follow-up and management. Long-term follow-up by urologists is essential.