Abstract Details

Title Transverse myelitis presentation and outcomes at the Kansas University Health System

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-070

Objective Review cases of transverse myelitis presenting to the Kansas University Health System (KUHS) to highlight challenges in diagnostic and treatment practices and to produce a TM diagnostic and treatment protocol.

Background Transverse myelitis (TM) is a CNS disorder that presents with a variety of phenotypes and poses a diagnostic dilemma for many clinicians. Idiopathic transverse myelitis and multiple sclerosis are the most common etiologies, however delays in diagnosis is common and can result in poor patient outcomes.

Design/Methods Using HERON, our repository ontological network, 95 cases of transverse myelitis were identified retrospectively from January 2006 to December 2017.

Results

37 patients were identified as idiopathic transverse myelitis, 23 patients as multiple sclerosis (average time to diagnosis: 12 months), 12 patients as NMO (average time to diagnosis: 4.8 months). 5 patients were identified as either possible or definitive sarcoidosis (average time to diagnosis: 13 months). 2 patients as Sjogren syndrome (average time to diagnosis: 15.5 months); 3 patients as infectious myelitis; 3 patients as B12 deficiency; and 10 patients had other etiologies of less frequency. In ITM cases, 27 patients experienced persistent neurologic deficit upon follow-up; 30 patients received methylprednisolone, while only 3 patients were escalated to IVIG or plasmapheresis.

Conclusions Transverse myelitis is a manifestation of a wide variety of etiologies with varying amounts of disability and outcomes. Our cohort highlighted the incidence of ITM (36%), multiple sclerosis (22%), NMO (12%), and sarcoidosis (5%), as well as the difficulty and length to reaching a definitive diagnosis. Although many patients experienced persistent neurological deficits upon their follow-up, escalation to secondary immunosuppression was rare. With this information, we aim to propose a diagnostic and treatment algorithm for optimizing patient care in patients presenting with their first episode of transverse myelitis.

Authors/Disclosures
Mark-Victor Siwoski, MD (BRONSON MEMORIAL HOSPITAL) PRESENTER	No disclosure on file
Yasir N. Jassam, MD, FRCP, FAAN (Hoag Specialty clinic)	Dr. Jassam has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Jassam has received research support from Roche, Chugai Pharmaceutical MedImmune LLC.Novartis, MedDay. Actelion, Alexion Pharmaceuticals,TG Therapeutics Alexion Pharmaceuticals, Teva Pharmaceuticals, Genentech phamarcetucal companies..

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