After getting out from under all of the snow, we have been keeping busy here in Baltimore so far this year at the Johns Hopkins Transverse Myelitis Center! Of note, recently the JHTMC was well-represented at the 2014 American Academy of Neurology, where the Center presented research on TM and other rare neuroimmunologic disorders. Among the research was a poster presentation entitled, “Differential Diagnosis of Transverse Myelitis,” (summary below), which was a retrospective analysis of 591 patients who presented to our Center over a 36-month period with the presumptive diagnosis of TM. We performed an in-depth analysis into the validity of patients’ diagnoses based on the available data to determine just how many patients had inflammatory TM, and determine how many actually had some non-inflammatory cause for their myelopathy. As you see from the attached results, two-thirds of patients who presented were confirmed to have inflammatory TM, and the majority of these were monophasic and idiopathic. Nonetheless, it should be noted that over a quarter of patients who presented to the JHTMC had a variety of non-inflammatory causes for their myelopathies, with the largest contenders for non-inflammatory myelopathies being attributable to compression, vascular, and metabolic etiologies. This large patient cohort alerts clinicians to recognize that the full differential diagnosis of TM is wide, and should draw attention to the fact that a comprehensive clinical work-up is necessary.
The JHTMC was honored by the Academy and by Jeffrey Dunn of Stanford University by having this research selected to be highlighted at a special MS/Neuroinflammatory session, where Dr. Dunn voiced that the research represented the high level of expertise coming out of the Johns Hopkins Transverse Myelitis Center.
The following other research posters in rare neuroimmunologic disorders were presented by the Johns Hopkins TM team at the AAN:
- A Note of Caution about the Diagnosis and Treatment of Suspected Transverse Myelitis where the potential negative impact of treating mimics of TM with acute therapies, specifically mimics caused by vascular myelopathies, were presented and discussed
- Adoptive Transfer of T-cells Reactive to Aquaporin-4 Creates Neuromyelitis Optica Mouse Model that suggests that NMO is a T-cell driven disease
- Trial of C1-Esterase Inhibitor in Acute Relapses of Neuromyelitis Optica which showed promising preliminary safety and efficacy results in our single-center open-label acute treatment trial of Cinryze for NMO relapses
- Cytokine Disarrangement and Increased Soluble Amyloid A (SAA) in Cerebrospinal Fluid (CSF) of Patients with Neurosarcoidosis presented a promising biomarker found in the CSF that would help to differentiate neurosarcoidosis from other neuroimmunologic disorders including NMO, MS, and monophasic idiopathic TM
Furthermore, Differentiating NMO- and MS-Associated Optic Neuritis by MRI was selected for platform presentation. Through retrospective analysis of 55 acute optic neuritis events, we demonstrated that MRI characteristics may be a useful biomarker in NMO, since lesions are more commonly longitudinally extensive and more posteriorly-based as compared to MS. This is useful since the NMO-IgG is likely to be negative in NMO patients who present with optic neuritis alone– it is not until later that they declare themselves as truly having NMO or NMOSD, after more damage has been done. Thus, being able to discover biomarkers that can potentially be utilized early in the disease is promising!
The excitement does not stop there, however. We can barely catch a breath from AAN as we jump into June – and we are delighted to announce that this past Monday, June 9th, 2014 has officially been recognized as Transverse Myelitis Awareness Day in the State of Maryland, thanks to the dedication of our patients in working with their local senators! So it is quite fitting that we are finishing our preparations for the Johns Hopkins 2nd Annual Regional Clinical Care Transverse Myelitis Symposium, happening later in the month on June 21st right here at the Johns Hopkins Hospital. This event, which is being supported by the Bart McLean Neuroimmunology Research Fund and through an educational grant provided by Alexion Pharmaceuticals, will focus on issues patients with TM and NMO most commonly encounter, as well as the latest trends in management of these issues, rehabilitation strategies, and new and developing research in TM and NMO. We are delighted to have expert faculty and staff from Johns Hopkins Medical Institutions, International Center for Spinal Cord Injury at the Kennedy Krieger Institute, and International Neurorehabilitation Institute… and it is going to be a full house! And the weekend fun does not stop there; for those who want to make it into an entire TM/NMO weekend extravaganza, the 2014 Maryland Walk-Run-N-Roll to support the TMA is the very next day!
Never a dull moment here at the Johns Hopkins Transverse Myelitis Center!
Maureen A. Mealy, RN, BSN, MSCN
Clinical Program Manager & Research Director
Johns Hopkins Transverse Myelitis Center & Neuromyelitis Optica Clinic