Immune-mediated myelopathies

PURPOSE OF REVIEW: This article presents data about inflammatory myelopathies, also referred to as transverse myelitis. While the idiopathic form of this condition is rare, the prevalence of transverse myelitis is relatively common when including all of the secondary causes, such as multiple sclerosis (MS). Thus, clinicians and researchers should be familiar with the presentations, diagnostic algorithms, treatment options, and long-term symptom management for patients with transverse myelitis. This review presents data about the idiopathic and secondary forms of transverse myelitis. RECENT FINDINGS: As research has expanded, the presentations of transverse myelitis have been clarified and the secondary causes explored. With the identification of the aquaporin-4 (AQP4) antibody, more patients with transverse myelitis have been categorized as having neuromyelitis optica (NMO), and more variable presentations have been published. A growing experience with various treatment options has expanded the therapeutic approaches to acute inflammatory myelopathies beyond standard corticosteroid intervention regimens. SUMMARY: Transverse myelitis can occur in isolation or as part of a larger systemic condition. An empiric approach to patient evaluation can accelerate diagnosis of secondary conditions. Mounting evidence suggests that an aggressive approach to therapy can improve patient outcomes, but large-scale prospective trials are lacking.