Abstract
Acute transverse myelitis (ATM) is a rare, immune-mediated pathology that is defined as an adverse inflammatory response in the spinal cord leading to neurologic injury. The pathophysiology of ATM is poorly understood, with no apparent differences in age, ethnicities, or race, along with variable radiographic and clinical presentation. Therefore, in this review, we will characterize what is known about ATM’s etiology and diagnostic criteria, and relate it to properties of neuroimmunology. Moreover, we will further discuss current treatment options, along with potential novel methods, to provide a comprehensive overview of the status of ATM’s research development. Among these novel treatments, potassium blockers reveal exciting early outcomes in restoring neurologic motor function. In addition, human glial progenitor cell transportations have been described as a potential treatment through integrating and remyelinating lesion sites. Nevertheless, despite these novel methods, there is a paucity of clinical trials establishing ATM’s immunopathology and the therapeutic role of potential treatment methods. Therefore, we will highlight the importance of larger well-designed clinical trials in revealing significant biomarkers of injury and recovery.
Highlights
BackgroundAcute transverse myelitis (ATM), first described in 1882, is a rare, immune-mediated inflammation of the spinal cord affecting people of any age, race, or gender [1, 2]
We describe the neuroimmunology of ATM along with the immunopathogenesis and the traditional treatment methods in order to set the foundation for describing the novel treatment methods from recent clinical trials
Clinical signs of ATM are propagated by an interruption in the ascending and descending neuroanatomical pathways located in the transverse plane of the spinal cord, causing a rapidly progressing muscle weakness or paralysis that initiates in lower extremities which spreads to upper extremities, dependent on affected spinal cord level, at varying degrees of severity [2, 4]
Summary
Acute transverse myelitis (ATM), first described in 1882, is a rare, immune-mediated inflammation of the spinal cord affecting people of any age, race, or gender [1, 2]. This demyelinating disorder encompasses a heterogeneous group of inflammatory disorders that can present as an acute and sub-acute dysfunction of the spinal cord, with a bimodal peak incidence among the ages of 10-19 years and 30-29 years, respectively [2]. A current and undergoing clinical trial, injured spinal cord pressure evaluation study-TM (ISCoPE-TM), proposes a novel diagnostic method consisting of an intraspinal pressure (ISP) and spinal cord metabolites monitoring devices in order to assess its feasibility and safety in patients with ATM [14]. Larger well-designed studies are warranted in order to further examine the effects of these novel treatments and to determine their therapeutic role
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