Transverse Myelitis

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Benjamin Greenberg - One of the best experts on this subject based on the ideXlab platform.

  • Clinical Approach to Pediatric Transverse Myelitis, NeuroMyelitis Optica Spectrum Disorder and Acute Flaccid Myelitis.
    Children (Basel Switzerland), 2019
    Co-Authors: Cynthia Wang, Benjamin Greenberg
    Abstract:

    Pediatric Transverse Myelitis (TM) is an acquired, immune-mediated disorder that leads to injury of the spinal cord and often manifests as weakness, numbness, bowel dysfunction, and/or bladder dysfunction. Multiple etiologies for Myelitis can result in a similar clinical presentation, including idiopathic Transverse Myelitis (TM), multiple sclerosis (MS), neuromyeltis optica spectrum disorder (NMOSD) associated with anti-aquaporin 4 antibodies, MOG antibody-associated disease, and acute flaccid Myelitis (AFM). Diagnosis relies on clinical recognition of the syndrome and confirming inflammation through imaging and/or laboratory studies. Acute treatment is targeted at decreasing immune-mediated injury, and chronic preventative therapy may be indicated if TM is determined to be a manifestation of a relapsing disorder (i.e., NMOSD). Timely recognition and treatment of acute Transverse Myelitis is essential, as it can be associated with significant morbidity and long-term disability.

  • anti myelin oligodendrocyte glycoprotein antibody associated with gray matter predominant Transverse Myelitis mimicking acute flaccid Myelitis a presentation of two cases
    Pediatric Neurology, 2018
    Co-Authors: Cynthia Wang, Ram Narayan, Benjamin Greenberg
    Abstract:

    Abstract Background Anti-myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders frequently manifest as optic neuritis, Transverse Myelitis, and acute disseminated encephaloMyelitis. While their clinical phenotypes overlap with relapsing inflammatory Central nervous system (CNS) conditions such as multiple sclerosis and neuroMyelitis optica spectrum disorder, MOG-related syndromes frequently occur in a younger age group. In children, longitudinally extensive Transverse Myelitis (LETM) is less specific for anti-aquaporin-4 associated neuroMyelitis optica spectrum disorder, and has also been reported in pediatric multiple sclerosis, idiopathic Transverse Myelitis, and acute flaccid Myelitis. Methods We summarize two patients with positive MOG antibodies and Myelitis. Results We identified two individuals with anti-MOG associated LETM that demonstrate primarily gray matter involvement. Clinically these patients exhibited hyperreflexia and had rapid improvement with immunotherapies. Conclusions Anti-MOG diseases can cause LETM with gray matter predominance mimicking acute flaccid Myelitis, but clinically these patients can have retained reflexes and respond favorably to immunotherapies.

  • pediatric Transverse Myelitis
    Neurology, 2016
    Co-Authors: Michael Absoud, Benjamin Greenberg, Ming Lim, Tim Lotze, Terrence Thomas, Kumaran Deiva
    Abstract:

    Pediatric acute Transverse Myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuroMyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions.

  • Transverse Myelitis plus syndrome and acute disseminated encephaloMyelitis plus syndrome a case series of 5 children
    JAMA Neurology, 2014
    Co-Authors: Allen Desena, Donna Graves, Michael C Morriss, Benjamin Greenberg
    Abstract:

    Importance Classically, Transverse Myelitis and acute disseminated encephaloMyelitis are considered central nervous system demyelinating conditions. In both conditions, the spinal cord is involved to varying degrees, and there is a variety of presentations, usually involving some degree of progressive paralysis of the upper and/or lower extremities. Treatment usually consists of high-dose intravenous steroids in addition to plasma exchange and/or intravenous immunoglobulin. In some cases, immunosuppressive medications, such as intravenous cyclophosphamide, have been used with variable success. Cases with atypical features on examination, imaging, or with neurophysiological studies may be helpful in shedding light on the etiology and/or pathophysiology because many of these patients have permanent disabilities despite appropriate treatment. Observations This case series presents 5 pediatric cases observed from 2009-2012 at our medical center, Children’s Medical Center Dallas. These cases were notable because they provided evidence of autoimmune events affecting the central nervous system but with additional peripheral axonal pathology. Conclusions and Relevance We describe these cases with respect to findings that suggest a variant of these conditions that have concomitant nerve-root involvement. These patients had worse outcomes than typical patients with Transverse Myelitis/acute disseminated encephaloMyelitis, and these observations build on previous work by other investigators that highlighted persistent flaccid paralysis and electrophysiological evidence of axonal loss portending a poorer prognosis. Furthermore, these cases suggest a potential role for approaching how we classify subtypes of Transverse Myelitis and acute disseminated encephaloMyelitis.

  • idiopathic Transverse Myelitis corticosteroids plasma exchange or cyclophosphamide
    Neurology, 2007
    Co-Authors: Benjamin Greenberg, Chitra Krishnan, K P Thomas, Adam I Kaplin, P A Calabresi, Douglas A. Kerr
    Abstract:

    Transverse Myelitis is a focal disorder of the spinal cord in which an immune-mediated process results in neural injury. In this large retrospective study, we compare patients who received one of four treatments to identify the most effective therapies. We identified subsets of patients who received clinical benefit from plasma exchange or cyclophosphamide being included in their treatment regimen.

Ramia Zakhour - One of the best experts on this subject based on the ideXlab platform.

Norma Perez - One of the best experts on this subject based on the ideXlab platform.

Brian G Weinshenker - One of the best experts on this subject based on the ideXlab platform.

  • novel glial targets and recurrent longitudinally extensive Transverse Myelitis
    JAMA Neurology, 2018
    Co-Authors: Jiraporn Jitprapaikulsan, Brian G Weinshenker, Sebastian Lopez A Chiriboga, Eoin P Flanagan, James P Fryer, Andrew Mckeon, Sean J Pittock
    Abstract:

    This cohort study presents serological data with regard to 2 novel glial targets (myelin oligodendrocyte glycoprotein and glial fibrillary acidic protein) in recurrent longitudinally extensive Transverse Myelitis.

  • longitudinally extensive Transverse Myelitis
    Current Opinion in Neurology, 2014
    Co-Authors: Oliver W Tobin, Brian G Weinshenker, Claudia F Lucchinetti
    Abstract:

    Purpose of reviewLongitudinally extensive Transverse Myelitis (LETM) is a frequently devastating clinical syndrome which has come into focus for its association with neuroMyelitis optica (NMO). Recent advances in the diagnosis of NMO have led to very sensitive and specific tests and advances in ther

  • Acute disseminated encephaloMyelitis, Transverse Myelitis, and neuroMyelitis optica.
    Continuum (Minneapolis Minn.), 2013
    Co-Authors: Dean M. Wingerchuk, Brian G Weinshenker
    Abstract:

    Purpose of review This review defines current clinical criteria for diagnosis, differential diagnosis, and clinical evaluation of acute disseminated encephaloMyelitis, Transverse Myelitis, and neuroMyelitis optica, and summarizes principles of treatment. Recent findings Consensus criteria for Transverse Myelitis and acute disseminated encephaloMyelitis have been proposed. A specific biomarker, aquaporin-4 autoantibody, has been discovered for neuroMyelitis optica that allows for early and accurate diagnosis even in the absence of cardinal findings of optic neuritis and Myelitis. The antibody is pathogenic and is facilitating an understanding of the pathophysiology of neuroMyelitis optica and development of antigen-specific treatments. Summary Clinical and radiologic findings combined with serologic findings may permit classification of syndromes of Transverse Myelitis and acute disseminated encephaloMyelitis in ways that may predict risk of relapse, type of relapse, and prognosis. Treatment, especially to prevent relapse, is dependent on the specific disease context in which syndromes such as Transverse Myelitis occur.

  • evidence based guideline clinical evaluation and treatment of Transverse Myelitis report of the therapeutics and technology assessment subcommittee of the american academy of neurology
    Neurology, 2011
    Co-Authors: Thomas F. Scott, J De Seze, Elliot M Frohman, Gary S Gronseth, Brian G Weinshenker
    Abstract:

    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 ® 2011;77:2128–2134

  • compressive myelopathy mimicking Transverse Myelitis
    The Neurologist, 2010
    Co-Authors: Brendan J Kelley, Bradley J Erickson, Brian G Weinshenker
    Abstract:

    Objectives:Spinal cord compression may be associated with a fusiform cord lesion on T2-weighted magnetic resonance imaging (MRI) images, leading to confusion with Transverse Myelitis and delaying effective surgical treatment.Results:We describe 5 patients referred for evaluation of suspected neuromy

G Piccolo - One of the best experts on this subject based on the ideXlab platform.

  • systemic sclerosis in aquaporin 4 antibody positive longitudinally extensive Transverse Myelitis
    Journal of the Neurological Sciences, 2011
    Co-Authors: Diego Franciotta, Elisabetta Zardini, Roberto Caporali, Laura Piccolo, Elisa Alberici, A Romani, Roberto Bergamaschi, Enrico Marchioni, Mauro Ceroni, G Piccolo
    Abstract:

    We report on the first patient with a relapsing, anti-aquaporin-4 (AQP-4) antibody-positive, longitudinally extensive Transverse Myelitis (LETM) who developed systemic sclerosis (SSc). A 62-year-old woman, who presented with bilateral, distal lower limb and perineal numbness, developed clinical manifestations and paraclinical features of SSc. Spinal cord imaging revealed lesions that were consistent with LETM. Patient's serum was positive for neuroMyelitis optica (NMO)-IgG/AQP-4 antibodies. High-dose intravenous corticosteroids improved the neurological symptoms. The present case expands the list of autoimmune systemic diseases that occur in neuroMyelitis optica spectrum disorders associated with NMO-IgG/AQP-4 antibodies.

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