Etiological spectrum, clinico-radiological profile and treatment outcomes of longitudinally extensive transverse myelitis – A prospective study from Northwest India

Abstract Objectives To study etiological, clinical and radiological profile and treatment outcomes in patients of longitudinally extensive transverse myelitis (LETM). Methods This was a prospective study conducted at Dr. S.N. medical college, Jodhpur, India, of patients presenting with LETM between March 2018 to March 2020. Results Our study included 32 patients (median age 32 years, female to male ratio of 2.5: 1). Neuromyelitis optica (NMO) was the most common diagnosis affecting 14 patients followed by 5 patients of idiopathic myelitis, 4 patients of para-infectious myelitis, 3 patients of multiple sclerosis (MS), 3 patients of acute demyelinating encephalomyelitis (ADEM) and 1 patient each of myelin oligodendrocyte glycoprotein (MOG) antibody disease, sarcoidosis and mixed connective tissue disorder (MCTD). All the patients of NMO were positive for aquaporin 4 (AQP4) antibody. Spinal MRI showed central pattern of involvement in NMO and eccentric pattern of involvement in MS. All the patients of para-infectious myelitis were varicella myelitis. Twenty-eight (87.5%) patients had good clinical recovery at 6 months. Conclusion Though, LETM is classically associated with NMO, it can have multiple etiologies. Identifying the etiology is important for long term treatment and prognosis which varies according to the disease. Patients presented with relapses and severe disease but had good clinical recovery with treatment.