Key result
Severe lower limb weakness linked to ~15-fold higher odds of poor early pediatric ATM response.
Why the study?
Data on early treatment response and associated factors in acute transverse myelitis remain limited, particularly in Southeast Asia.
Case-Control (n=56)
Odds Ratio: 14.7 (95% CI 3–73.2)
p-value: p=<0.05
Severe motor and respiratory involvement at presentation, as well as the absence of MOG antibodies, are key indicators of poor early treatment response in pediatric acute transverse myelitis.
Severe lower limb weakness may flag high-risk pediatric ATM cases for monitoring; leaves open need for prospective validation before guiding care.
Background and Objectives: Acute transverse myelitis (ATM) is a rare inflammatory spinal cord disorder causing significant motor, sensory, and autonomic dysfunction in children. Although advances in diagnosis and therapy have improved outcomes, data on early treatment response and associated factors remain limited, particularly in Southeast Asia. This study aimed to identify clinical, radiological, and immunological factors associated with early in-hospital response in children with ATM in Vietnam. Methods: This retrospective case-control study included 56 children under 18 years of age diagnosed with ATM between 2018 and 2023. Participants were divided into a case group (poor early response, n = 29) and a control group (good early response, n = 27) based on their functional status at discharge, as assessed by the Paine and Byers scale. Clinical, cerebrospinal fluid (CSF), and magnetic resonance imaging (MRI) findings, as well as myelin oligodendrocyte glycoprotein (MOG) and aquaporin-4 (AQP4) antibody results, were analyzed. Logistic regression was performed to identify factors associated with poor early response. Results: Severe lower limb motor weakness (Medical Research Council [MRC] muscle strength scale ≤ 1) at admission was independently associated with poor early response (OR 14.7, 95% CI: 3.0–73.2, p < 0.05). Respiratory muscle weakness, the need for mechanical ventilation, and the absence of MOG antibodies were also linked to poor early outcomes. Radiological features, including longitudinally extensive transverse myelitis (LETM), cervical involvement, and gadolinium enhancement, were not significantly associated with early response. Conclusions: Severe motor and respiratory involvement at presentation were key indicators of poor early treatment response in pediatric ATM. Recognizing these factors promptly may guide risk stratification and early management. Longitudinal studies are needed to evaluate their predictive value for long-term recovery.
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Huong et al. (2026) conducted a case-control in Acute transverse myelitis (ATM) (n=56). Severe lower limb motor weakness at admission was evaluated on Poor early response at discharge (OR 14.7, 95% CI 3.0-73.2, p=<0.05). Severe lower limb motor weakness at admission was independently associated with poor early in-hospital response in pediatric acute transverse myelitis (OR 14.7; 95% CI 3.0-73.2; p<0.05).
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