Acute transverse myelitis (ATM)

Childhood acute transverse myelitis (ATM) occurs when the immune system targets the spinal cord. ATM is a rare but potentially devastating condition with varying possible outcomes. Weakness or paralysis of the legs and/or arms, incontinence and constipation, and loss of sensation usually develop over several hours, and can progress to a severely disabling state.

ATM needs to be distinguished from other rarer spinal cord disorders. ATM may also be an early sign of chronic diseases such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The criteria for diagnosing ATM are generally relevant for children, but some modifications may be necessary in young children.

In ATM, MRI lesions tend to affect a large segment of the spinal cord. MRI lesions of the brain that do not cause symptoms are seen in more than one-third of children with ATM and predict MS or NMO. Children generally have a better outcome than adults, with 50% making a complete recovery within two years.

There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study to date currently open to recruitment.

A recent IPMSSG paper reviews the current knowledge of how ATM develops, its clinical features, the recommended diagnostic workup and management strategies, and suggests future research directions.