Acute pediatric myelitis – cohort of 20 patients

Aim: In this study, we focused on the cur rent is sue of pediatric myelitis and shared our clinical experience. Patients and methods: 20 patients (10 girls, 10 boys; age 4-17 years, median 14 years; follow-up period 1-73 months, median 15 months) with acute spinal syndrome and without encephalopathy; acute spinal compression was excluded and inflammatory etiology was considered. Analysis of clinical and para-clinical data (magnetic resonance imaging [MRI] of the brain and spinal cord, cerebrospinal fluid examination, microbiological and immunological testing, serum aquaporin 4 antibodies). We evaluated the clinical course, response to acute therapy and the final diagnosis; whether the cur rent international diagnostic criteria were fulfilled for clinically isolated syndrome (CIS), pediatric multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMOSD). Results: One patient had infectious Borrelia-related myelitis. Acute myelitis as a symptom of CIS/MS was in eight cases and as a symptom of NMOSD in three cases. Idiopathic myelitis was diagnosed in eight children. CIS/MS patients in comparison to NMOSD patients had different clinical courses, laboratory findings and responses to acute therapy. The most serious were patients with idiopathic myelitis - with rapid progression of spinal symptoms and extensive spinal lesions detected using MRI of spinal cord. They had poor response to corticotherapy. Some of these patients were successfully treated with combined immunosuppression. Conclusions: Acute myelitis is a complicated diagnosis, which requires a comprehensive approach and clinical experience.