CLINICAL PRESENTATION AND OUTCOME OF ACUTE TRANSVERSE MYELITIS IN BANGLADESH: A HOSPITAL-BASED CASE-CONTROL STUDY

Abstract

Intro: Acute transverse myelitis (ATM) is an inflammatory neurological disorder causing spinal-cord injury characterized by sensory, motor or autonomic dysfunction. Till date, most studies conducted worldwide on ATM were among pediatric patients and population-based studies are limited. We aimed to describe the clinical presentation, severity and outcome of ATM in Bangladesh. Methods: We conducted a prospective case-control study from 2015 to 2019 at Dhaka Medical College Hospital, Dhaka, Bangladesh with standard time-points of follow-up for 1 year. Patients were enrolled using diagnostic criteria by TM Consortium Group. Detailed history, physical examination and MRI were performed and biological samples were collected as per pre-defined protocol. Findings: A total of 97 ATM cases were enrolled with 55% female and median age of 28 years (IQR, 19-39). Presented first symptoms were muscle/joint pain (34%), muscle weakness (31%) and urinary retention (17%). Preceding events within 6 weeks prior to weakness were reported by 29% patients, predominantly respiratory illness (N=20), followed by diarrhea (N=11). At enrollment, 87% patients were bed bound. Most of the patients had symmetrical (82%) and ascending (42%) type of motor weakness. Definite sensory level, bowel-bladder involvement and cranial-nerve involvement were found in 81%, 83% and 20% patients respectively. Mortality was 14% and poor outcome (Hughes disability score ≥2) were found in 36% and 22% patients after week 2 and 6 months of disease onset respectively. At week 2 and 6 months, 35% and 17% patients had total/severe dependency for activities of daily living (Barthel score ≤60). No clinical associated factors have been found for poor outcome and death of ATM patients in Bangladesh. Conclusion: In Bangladesh, most patients presented with severe form of disease and significant proportion of patients had poor outcome even after 6 months of disease onset. Population-based studies are needed to evaluate the risk factors of poor outcome among ATM patients.