Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
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DOI：
10.1212/wnl.0b013e31823dc535
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发表时间：
2011-12-01
期刊：
影响因子：
9.9
通讯作者：
Weinshenker, B. G.
中科院分区：
文献类型：
--
作者：
Scott, T. F.;Frohman, E. M.;Weinshenker, B. G.
目的：为评估横肌萎缩症（transverse myeloma，TM）诊断和治疗的证据，并提出循证建议。方法：对1966年至2009年3月发表的文献进行回顾，对相关文献进行循证分类。视神经肌萎缩症（NMO）-免疫球蛋白G（IgG）抗体应被认为有助于确定临床急性完全性横肌萎缩症（ACTM）患者的TM病因功能. NMO-IgG抗体（水通道蛋白-4特异性抗体）的存在应被认为有助于确定TM复发风险增加。C级建议：在疑似TM中，ACTM或急性部分横肌萎缩之间区别可能被认为有助于确定TM病因和复发风险（更常见于APTM）。年龄和性别可能被认为有助于确定TM综合征患者的病因，脊柱梗死在老年患者中更常见，女性比男性多发性硬化症（MS）患者更容易发生TM。与MS的脑MRI特征一致的脑MRI特征可能被认为有助于预测第一次部分TM发作后向MS的转化。延伸超过3个椎体节段的较长脊柱病变可被认为有助于确定NMO与MS。CSF细胞和寡克隆带检查可被认为有助于确定TM综合征的病因。对于皮质类固醇治疗后未能改善的TM患者，可考虑进行血浆置换。利妥昔单抗可以考虑在TM患者由于NMO，以减少复发的数量。U级建议：没有足够的证据支持或反驳其他TM疗法的疗效或种族对确定亚急性脊髓病病因的有用性。神经病学（R）2011; 77：2128-2134
Objective: To assess the evidence for diagnostic tests and therapies for transverse myelitis (TM) and make evidence-based recommendations.Methods: A review of the published literature from 1966 to March 2009 was performed, with evidence-based classification of relevant articles.Recommendations: Level B recommendations: neuromyelitis optica (NMO)-immunoglobulin G (IgG) antibodies should be considered useful to determine TM cause in patients presenting with clinical acute complete transverse myelitis (ACTM) features. The presence of NMO-IgG antibodies (aquaporin-4-specific antibodies) should be considered useful in determining increased TM recurrence risk. Level C recommendations: in suspected TM, distinction between ACTM or acute partial transverse myelitis may be considered useful to determine TM etiology and risk for relapse (more common with APTM). Age and gender may be considered useful to determine etiology in patients presenting with TM syndrome, with spinal infarcts seen more often in older patients and more female than male patients having TM due to multiple sclerosis (MS). Brain MRI characteristics consistent with those of MS may be considered useful to predict conversion to MS after a first partial TM episode. Longer spinal lesions extending over >3 vertebral segments may be considered useful in determining NMO vs MS. CSF examination for cells and oligoclonal bands may be considered useful to determine the cause of the TM syndrome. Plasma exchange may be considered in patients with TM who fail to improve after corticosteroid treatment. Rituximab may be considered in patients with TM due to NMO to decrease the number of relapses. Level U recommendations: there is insufficient evidence to support or refute the efficacy of other TM therapies or the usefulness of ethnicity to determine the cause of a subacute myelopathy. Neurology (R) 2011; 77: 2128-2134