A pilot study of mycobacteria infection in incomplete transverse myelitis refractory to steroids

Abstract

Objective Incomplete transverse myelitis (ITM) of unknown origin is associated with high rates of morbidity and mortality，and treatment options for these patients are few. This pilot study was undertaken to determine whether antituberculous treatment(ATT)might help in patients with ITM whose condition continued to worsen despite receiving IV methylprednisolone treatment. Methods This is a prospective，open-label study. A group of 67 patients with steroid-refractory ITM were included from Jan 2003 to Jun 2009，and known causes of myelopathy were excluded.They underwent trial chemotherapy of ATT. All patients were followed up for at least 1 year after treatment.Efficacy was assessed by the ASIA scoring system，Barthel Index(BI)and Hauser Ambulation Index(AI)at baseline and at 12 months，and magnetic resonance imaging(MRI)changes were also assessed. Results Of 67 patients enrolled，16 withdrew. 51 patients completed the entire course of treatment;and were able to be assessed. At 12 months，49 patients experienced benefits. ASIA rating，BI significantly increased，Hauser AI improved validity，concomitantly with markedly decreased abnormal signals in spinal cord on MRI over time. Conclusions The results from this perspective study provide beneficial clinical and MRI data on the efficacy of ATT in ITM patients，and suggests mycobacteria may be an important and being neglected infection of myelitis.