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Inflammatory transverse myelitis: evolving concepts

Pittock, Sean J; Lucchinetti, Claudia F

doi: 10.1097/01.wco.0000236615.59215.d3
Inflammatory diseases and infection

Purpose of review: Acute transverse myelitis is a pathogenetically heterogeneous inflammatory disorder of the spinal cord. Here we describe recent advances in inflammatory non-infectious transverse myelitis. Particular attention will be paid to the serum autoantibody marker NMO-IgG and its application to acute transverse myelitis.

Recent findings: The recent identification of neuromyelitis optica-IgG, a novel marker of neuromyelitis optica spectrum disorders (including longitudinally extensive transverse myelitis), contributes to an evolving understanding of acute transverse myelitis. Other serological markers, such as collapsin response-mediator protein-5 -IgG and amphiphysin-IgG, predict specific cancers in the setting of a paraneoplastic acute transverse myelitis. Furthermore, novel inflammatory markers such as interleukin-6 or other proteins in their signaling pathways may represent markers of disease severity and potential therapeutic targets. Additional cerebrospinal fluid biomarkers, such as protein 14-3-3 and neuron-specific enolase, may be useful prognostic indicators in transverse myelitis. Acute transverse myelitis in children, in contrast to adults, is more likely to be longitudinally extensive, and has a better prognosis and lower likelihood of recurrence. Prognostic factors in pediatric transverse myelitis are reviewed.

Summary: The recent identification of novel biomarkers associated with acute transverse myelitis has led to a better understanding of the spectrum of disorders associated with inflammatory transverse myelitis, as well as a greater appreciation of its diverse and complex pathogenetic basis.

Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Correspondence to Sean J. Pittock, MD, or Claudia F. Lucchinetti, MD, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA Tel: +1 507 538 1039; fax: +1 507 284 4795; e-mail: Pittock.sean@mayo.edu or Lucchinetti.Claudia@mayo.edu

© 2006 Lippincott Williams & Wilkins, Inc.