Risk Factors For Acute Transverse Myelitis To Relapse

Objective: retrospectively analysis the differences between acutetransverse myelitis and recurrent acute transvers myelitis, to determine the riskfactors to cause ATM to relapse.Methods:60patients who presented with first attack of ATM withoutkown clinical history of CNS demyelinating diseases in the second hospital ofHeBei Medical University between January2005and December2009wereretrospectively studied. Phoned all include patients to obtain whether they hada recurrence of CNS demyelinating diseases, the deadline is December2012.The patients were divided into the ATM group and the recurrent ATMgroup, we compared the demographics, clinical character, imaging andauxiliary examination results in the two groups, to determine the risk factors tocause ATM to recur.Diagnosis of ATM followed the diagnostic criteria of the TransverseMyelitis Consortium Working Group（2002）. These required the inclusioncriteria of:(1) development of sensory, motor or autonomic dysfunctionattributable to the spinal cord;(2) bilateral signs and/or symptoms;(3) clearlydefined sensory level;(4) progression to nadir between4hours and21daysfollowing symptoms onset (5) inflammation of cord demonstrated by CSFpleocytosis or elevated IgG index or gadolinium enhancement, either presentat onset or between2and7days after onset; and exclude reasonablemyelopathy inclding vascular myelopathy, spinal cord irradiation,spinal cordcompression, spinal cord neoplasms and so on. Diagnosis of MS was based onPoser criteria(1983)or McDonald criteria(2001),and NMO fulfilled thediagnostic criteria of Wenshenker(2006).Recurrent myelitis was defined as asthe internal period between the first and the second was more than one monthand the appearance or worsening of symptoms of neurologic dysfunction dueto the spinal cord, there were no other symptoms beyond the spinal cord. Ralapses were defined as the internal period between the first and the secondwas more than one month and the appearance or worsening of symptoms ofneurologic dysfunction due to CNS demyelination lasting more than24hours.We used SPSS16.0to analysis the data. The numeration data wasexamed by x2test, the measurement data was compared with t-test or theMann-Whitney test.Results:60of ATM patients were enrolled in this study, five patientswere lost contact, the follow-up period was4to9years, mean time was6.62years. There were39cases in the ATM group and16cases in the recurrentATM group, the recurrent rate is29.1%, among them5patients underwentconversion to NMO,8patients underwent conversion to MS,3patientsexperienced another ATM attack.5patients were died in the follow-upperiod,4were in the ATM group and1was in the recurrent ATM group, allcauses of death were infection.Among the ATM group, there were22male17female,male:female=1.3:1, among the recurrent group there were4male,12female,male:female=1:3, P=0.034.There were2patients in the ATM group hadanother sysdemic autoimmune disease compared with6in the recurrent ATMgroup, P=0.008. There were24patients’ first manifestation during the ATMperiod were myasthenia in the ATM group compared with3in the recurrentgroup, P=0.004.15patients in the ATM group had VEP exams,4wereabnormal, among the recurrent group8patients had VEP exams,6wereabnormal, P=0.039.14patients in the ATM group had brain MRI exams,2were abnormal,10patients in the recurrent ATM group had brain MRIexams,7were abnormal, P=0.019.There were manifest differences in thegender, complication of another sysdemic autoimmune disease, the firstmanifestation of myathenia, abnormal VEP and brain MRI exams in the twogroups. Other factors like age of onset, the mean EDSS score during the peakof the illness, BAEP, spinal cord MRI and CSF parameter didn’t havemanifest differences.Conclusion: most ATM were monophasic course. Female, complication of another sysdemic autoimmune disease, abnormal VEP and brain MRIexams were connected to relapse, yet myasthenia as the first manifestation ofATM was not likely to recur.