Which Treatment Is Best for Transverse Myelitis?

Idiopathic transverse myelitis (TM) is heterogenous, even after excluding structural, vascular, and other mimics. TM with small peripheral MRI lesions is a harbinger of multiple sclerosis and has a good short-term prognosis for recovery. TM with long, central lesions extending over 3 or more vertebral segments commonly causes severe deficits and may be refractory to corticosteroids. The optimal treatment of patients with severe, corticosteroid-refractory deficits is unknown.

Greenberg and colleagues retrospectively reviewed 5 years of TM treatment experience at one center. The 122 patients had been treated with intravenous methylprednisolone alone or followed by plasma exchange (PLEX), intravenous cyclophosphamide, or both. In patients with …