Investigators at Children's Hospital of Chongqing Medical University, China, reviewed children diagnosed with acute transverse myelitis (ATM) between 1995 and 2008 and selected 39 patients diagnosed according to the new Johns Hopkins Consortium criteria [1]. At a mean follow-up period of 102.7 months, 31 had a good outcome and 8 did poorly. Risks of poor prognosis included secondary infection, increased CSF protein, short time to maximal deficit, long time to peak neurological impairment, and initial duration of treatment. Children with these risk factors were more likely to have residual neurological deficits, resulting in lower qualities of life. Conversion to multiple sclerosis occurred in 2 patients (5.1%). Additional poor prognostic factors included flaccid paraparesis, respiratory failure, age < 6 months, and spinal shock. Good prognostic factors were a plateau shorter than 8 days, supraspinal symptoms, independent walking at <1 month, hyperreflexia and Babinski reflex. [2]

COMMENTARY. In a follow-up study of 47 children with ATM at Johns Hopkins, Baltimore, a febrile illness had occurred in 47% and vaccination in 28%. At the nadir of the illness, 89% were unable to walk, required assisted ventilation, or both. At a median of 3.2 years after the acute illness, 43% were unable to walk 30 ft, 68% had urinary urgency, 55% had dysesthesias, and 75% had numbness. Age at onset <3 years was associated with a worse functional outcome. [3]. A longer follow-up period and effect of rehabilitation may explain the better prognosis in the Chinese study group.