Long-term Follow-up of Acute Partial Transverse Myelitis

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Abstract
Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system affecting young adults in Western countries. It is characterized by a huge interindividual variability of clinical symptoms and an unpredictable course ranging from asymptomatic sequelae to severe disability. Early initiation of treatment has proved effective in delaying the second neurological episode and reducing long-term disability.1 It is therefore mandatory to identify as early as possible patients who may develop the disease. First attacks of MS, also called clinically isolated syndrome (CIS), usually consist of optic neuritis, brainstem involvement, or partial myelitis. Conversion rates of CIS to MS have previously been studied in 3 populations of patients presenting with CIS: a patient population in London, England, over periods of 7, 14 and 20 years2,3; in Barcelona, Spain, over 7 years4; and in North America, electively concerning optic neuritis, over 15 years.5 In these 3 studies, the probability of developing MS ranged from 42% to 63%, but the authors of these studies did not analyze each initial symptom, especially acute partial transverse myelitis (APTM). This specific manifestation was only referred to in small and retrospective studies: the conversion rate to MS was evaluated at between 11% and 57.7%.6-10 Some predictive factors for conversion from CIS to MS have been identified: sensory symptoms,7 presence of oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF), and presence of brain lesions detected on magnetic resonance imaging (MRI) scans.7,10