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Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
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Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

T. F. Scott, E. M. Frohman, J. De Seze, G. S. Gronseth, B. G. Weinshenker and Therapeutics and Technology Assessment Subcommittee of American Academy of Neurology
Neurology, v 77(24), pp 2128-2134
01 Dec 2011
PMID: 22156988
url
https://doi.org/10.1212/wnl.0b013e31823dc535View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open
url
https://doi.org/10.1212/WNL.0b013e31823dc535View
Published, Version of Record (VoR) Open

Abstract

Clinical Neurology Life Sciences & Biomedicine Neurosciences & Neurology Science & Technology
Objective: To assess the evidence for diagnostic tests and therapies for transverse myelitis (TM) and make evidence-based recommendations. Methods: A review of the published literature from 1966 to March 2009 was performed, with evidence-based classification of relevant articles. Recommendations: Level B recommendations: neuromyelitis optica (NMO)-immunoglobulin G (IgG) antibodies should be considered useful to determine TM cause in patients presenting with clinical acute complete transverse myelitis (ACTM) features. The presence of NMO-IgG antibodies (aquaporin-4-specific antibodies) should be considered useful in determining increased TM recurrence risk. Level C recommendations: in suspected TM, distinction between ACTM or acute partial transverse myelitis may be considered useful to determine TM etiology and risk for relapse (more common with APTM). Age and gender may be considered useful to determine etiology in patients presenting with TM syndrome, with spinal infarcts seen more often in older patients and more female than male patients having TM due to multiple sclerosis (MS). Brain MRI characteristics consistent with those of MS may be considered useful to predict conversion to MS after a first partial TM episode. Longer spinal lesions extending over >3 vertebral segments may be considered useful in determining NMO vs MS. CSF examination for cells and oligoclonal bands may be considered useful to determine the cause of the TM syndrome. Plasma exchange may be considered in patients with TM who fail to improve after corticosteroid treatment. Rituximab may be considered in patients with TM due to NMO to decrease the number of relapses. Level U recommendations: there is insufficient evidence to support or refute the efficacy of other TM therapies or the usefulness of ethnicity to determine the cause of a subacute myelopathy. Neurology (R) 2011; 77: 2128-2134

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Clinical Neurology
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