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Myelitis — Clinical Guidelines

Overview

Myelitis refers to inflammation of the spinal cord, leading to neurological deficits including motor, sensory, and autonomic dysfunction. It can be categorized into infectious and non-infectious causes, with non-infectious forms often immune-mediated 2 3 7.

Diagnosis

Clinical Presentation: Motor, sensory, and autonomic dysfunction 7.

Imaging: MRI often shows characteristic spinal cord lesions 6.

Lumbar Puncture: Elevated protein levels, pleocytosis, and oligoclonal bands may be present 7.

Differential Diagnosis: Exclude infectious causes, multiple sclerosis, and other inflammatory spinal cord disorders 7.

Specific Criteria: Proposed diagnostic criteria emphasize focal spinal cord involvement and exclusion of other causes 7.

Management

First-Line Treatments:

- Corticosteroids: High-dose intravenous methylprednisolone often used acutely 4. - Immunosuppressive Agents: Plasma exchange or intravenous immunoglobulin (IVIG) in refractory cases 4.

Adjunctive Treatments:

- Physical Therapy: Early mobilization and rehabilitation to prevent complications 4. - Symptomatic Care: Pain management, bowel/bladder care, and spasticity management 4.

Special Populations

Pregnancy: Transverse myelitis during pregnancy requires careful management balancing maternal and fetal health; specific treatment protocols are not well-documented 9.

Pediatrics: Children with transverse myelitis benefit from multidisciplinary care centers focusing on acute care and long-term follow-up 4.

Elderly: Older adults may have additional comorbidities affecting treatment choices and outcomes 4.

Key Recommendations

Establish a Multidisciplinary Approach: Develop and utilize multidisciplinary care centers for comprehensive management, especially in pediatric patients 4 (Evidence: Moderate).

Early Use of Corticosteroids: Initiate high-dose intravenous corticosteroids early in the course of acute transverse myelitis 4 (Evidence: Moderate).

Consider Immunosuppressive Therapy: For refractory cases, consider plasma exchange or IVIG 4 (Evidence: Moderate).

Implement Early Rehabilitation: Incorporate physical therapy and rehabilitation early to mitigate long-term disability 4 (Evidence: Moderate).

Differentiate from Other Conditions: Rigorously exclude other causes like infectious myelitis and multiple sclerosis to confirm diagnosis 7 (Evidence: Strong).

References

1 Li J, Liu Y, Liu Z, Li X. Tear cytokine levels in Sjogren's syndrome-related dry eye disease compared with non-Sjogren's syndrome-related dry eye disease patients: A meta-analysis. Medicine 2024. link 2 Zhou H, Zhang X, Bian L, Wang L, Wang Y, Zhao X. An analysis of cervical non-infectious inflammatory myelitis risk factors. Neurological research 2014. link 3 Stübgen JP. Immune-mediated myelitis associated with hepatitis virus infections. Journal of neuroimmunology 2011. link 4 Trecker CC, Kozubal DE, Quigg M, Hammond E, Krishnan C, Sim PA et al.. Quality care in transverse myelitis: a responsive protocol. Journal of child neurology 2009. link 5 Venegas Fanchke P, Sinning M, Miranda M. Primary Sjogren's syndrome presenting as a generalized chorea. Parkinsonism & related disorders 2005. link 6 Hammerstedt HS, Edlow JA, Cusick S. Emergency department presentations of transverse myelitis: two case reports. Annals of emergency medicine 2005. link 7 . Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002. link 8 Singh TS, Rana D. Urogenital myiasis caused by Megaselia scalaris (Diptera: Phoridae): a case report. Journal of medical entomology 1989. link 9 Truter PJ, van der Merwe JV. Transverse myelitis caused by schistosomiasis during pregnancy. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1987. link 10 Fox RI, Howell FV, Bone RC, Michelson P. Primary Sjogren syndrome: clinical and immunopathologic features. Seminars in arthritis and rheumatism 1984. link90001-5) 11 Pagani JJ, Collins JD, Reza MJ. Sjogren syndrome presenting as pulmonary pseudolymphoma: report of a case. Journal of the National Medical Association 1979. link

Myelitis