From the Guidelines
The chance of developing partial transverse myelitis is approximately 50-60% of all transverse myelitis cases, with the overall incidence estimated at 1-8 cases per million people annually. Partial transverse myelitis, which affects only a portion of the spinal cord cross-section, typically presents with asymmetric symptoms and may involve sensory deficits, motor weakness, or autonomic dysfunction limited to one side of the body or affecting certain functions more than others.
Key Points
- The prognosis for partial transverse myelitis is generally better than for complete transverse myelitis, with approximately 50-70% of patients experiencing good recovery 1.
- Treatment typically involves high-dose intravenous methylprednisolone (1000mg daily for 3-5 days), followed by oral prednisone taper, and in some cases, plasma exchange therapy for those who don't respond to steroids.
- Early diagnosis and prompt treatment are crucial for improving outcomes, as delays can lead to more permanent neurological damage.
- The condition may occur as an isolated inflammatory event or as part of broader conditions like multiple sclerosis or neuromyelitis optica spectrum disorders, which affects both the risk and long-term management approach.
Diagnosis and Management
- Diagnostic work-up should include MRI of the brain and/or spine with and without contrast and CSF analysis, including cytology, to rule out leptomeningeal metastasis 1.
- For mild (grade 1) neurologic symptoms, checkpoint inhibitor therapy may be continued under close observation, while for grade 2 or higher neurologic symptoms, checkpoint inhibitor therapy should be held until the nature of the irAE and symptom progression is defined.
- Symptom control may require escalation of corticosteroid therapy to pulse-dose methylprednisolone (1 g daily for 5 days) in addition to IVIG, or plasma exchange (PEX) 1.
Recent Guidelines
- The American College of Radiology (ACR) recommends that all patients with acute onset myelopathy require evaluation for extrinsic compression of the spinal cord, and that inflammatory conditions such as demyelinating diseases, systemic inflammatory diseases, and infection should be considered 1.
From the Research
Chance of Partial Transverse Myelitis
- The chance of partial transverse myelitis is not explicitly stated in the provided studies, but it is mentioned that transverse myelitis can lead to a partial or total transverse lesion of the spinal cord structures 2.
- The studies suggest that the severity of transverse myelitis can vary, with some patients experiencing moderate to severe residual disability, while others may have a full recovery 3, 4.
- The treatment and outcome of transverse myelitis depend on the underlying etiology, and high-dose corticosteroids have been shown to be effective in some cases 4, 5.
- The proportion of patients with partial transverse myelitis is not specified, but it is noted that idiopathic transverse myelitis accounts for about 10-40% of cases, and the disease can have a serious course leading to persistent neurological damage and permanent disability 2, 6.