Cognitive Deficits in Pediatric Transverse Myelitis Patients: An Unexpected Finding (P04.108)

Abstract

Objective: The objective of this study was to quantify the prevalence and severity of cognitive dysfunction among pediatric transverse myelitis (TM) patients, controlling for concomitant medication use and depression. Background Idiopathic TM is diagnosed based on evidence of inflammation within the spinal cord, in the absence of cerebral involvement. This differentiates it from acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). In pediatric ADEM and MS, cognitive dysfunction is expected and well described within the literature. Up to 20% of transverse myelitis (TM) cases manifest before adulthood. Problems with cognitive and psychological functioning in TM patients have been observed anecdotally; however, no empirical data exists regarding cognitive and psychological outcomes in this population. Within our pediatric demyelinating disease center, we had observed some individual cases of cognitive dysfunction among our TM population and began a formal assessment of these patients. At the initiation of this project, any evidence of cognitive dysfunction was typically attributed to concomitant depression or medication use. This abstract provides the first ever evidence of unexplained cognitive dysfunction in pediatric TM patients. Design/Methods: TM patients seen at our multidisciplinary care clinic were routinely screened for evidence of depression and/or cognitive deficits. This data was retrospectively reviewed under an IRB approved protocol. Data about diagnosis, medication use, comorbid depression, MRI findings, and cognitive function were extracted from the clinical record into SPSS. Twenty-four patients were included in the analysis and the prevalence of cognitive deficits determined. Results: Forty-seven percent of pediatric TM patients were found to be cognitively impaired if screening tests included fine-motor components. Seventeen percent of pediatric TM had evidence of cognitive dysfunction when tasks requiring a fine-motor component were excluded. There was not a contribution from medication use or depression. Conclusions: This is the first study ever to document evidence of cognitive dysfunction among pediatric TM patients. Disclosure: Dr. Harder has nothing to disclose. Dr. Graves has nothing to disclose. Dr. Spurgin has nothing to disclose. Dr. Greenberg has received personal compensation for activities with DioGenix, Greater Good Foundation, Biogen Idec, Serono, Inc., Sanofi-Aventis Pharmaceuticals, Inc., the Multiple Sclerosis Association of America and Teva Neuroscience as a consultant and/or speaker. Dr. Greenberg holds stock and/or stock options in Diogeix. Dr. Greenberg has received research support from Guthy-Jackson Charitable Foundation, Amplimmune, Inc. and the Accelerated Cure Project.