NMO-IgG-negative relapsing myelitis

Spinal Cord. 2009 Jul;47(7):531-7. doi: 10.1038/sc.2008.157. Epub 2008 Dec 23.


Objective: Idiopathic transverse myelitis (I-TM) is typically monophasic, while relapsing forms are usually referred to spinal cord-restricted neuromyelitis optica (NMO), atypical multiple sclerosis (MS), or myelitis during the course of infections and connectivitis. Our objective was to evaluate the frequency of recurrent I-TM; to clarify the nosology of these forms through comparison with NMO and post-infectious TM (P-TM).

Design: Prospective cohort study on patients presenting with I-TM was carried out inpatients of Infectious and Neurologic Disease Clinics, Italy.

Methods: Over an 8-year period, we recruited 13 patients with I-TM and 16 with P-TM. The patients were followed-up for at least 3 years with repeated brain and spinal cord magnetic resonance imaging (MRI) examinations, multimodal evoked potentials and serum screen for connectivitis. Relapses were defined on clinical and imaging criteria.

Results: Four patients with I-TM (31%) had a relapsing course . They were all males with age >50, and severe at-onset disability. The final outcome was poor in three out of four patients. Serum NMO-immunoglobulin G was undetectable in all patients. Longitudinally extensive myelitis was not predictive of relapses. I-TM and P-TM shared clinical, cerebrospinal fluid (CSF) and MRI features, as well as a similar rate (54 vs 38%) of peripheral nervous system involvement (polyradiculoneuritis), and an identical rate of relapses (31% for both forms).

Conclusions: Our series support the existence of relapsing I-TM as a disease entity that does not appear related to NMO, nor to MS, cannot be further specified and shares many features with P-TM. The likelihood of relapses was unpredictable based on clinical, CSF and MRI findings.

MeSH terms

  • Adult
  • Aged
  • Autoantibodies
  • Brain / pathology
  • Cohort Studies
  • Female
  • Humans
  • Immunoglobulins / blood*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myelitis, Transverse / blood
  • Myelitis, Transverse / diagnosis*
  • Recurrence
  • Retrospective Studies
  • Serologic Tests
  • Spinal Cord / pathology
  • Young Adult


  • Autoantibodies
  • Immunoglobulins