Abstract Details

Title Outcomes and prognostic factors in myelopathies

Topic Multiple Sclerosis

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-005

Objective To compare functional outcomes in inflammatory myelopathies (IM) and vascular myelopathies (VM) and determine prognostic factors.

Background IM and VM may present with similar clinical profiles but involve different pathophysiology mechanisms that can lead to different functional outcomes.

Design/Methods In this retrospective observational study including IM and VM subjects followed at the Johns Hopkins Myelitis Myelopathy Center (JHMMC), between 2010 and 2020, the modified Rankin scale (mRS) and the American Spinal Injury Association Impairment (ASIA) scale were evaluated at presentation and at the 2 subsequent follow up visits and compared between groups. Predictors of disability at follow up were identified by using logistic regression considering clinical, neuroimaging and CSF profiles at initial presentation.

Results One hundred forty-five IM and 75 VM (38 strokes and 37 AVF) patients were included. As compared to IM, the VM group had worst mRS scores and ASIA scores (more subjects with type A and B injury) at initial presentation and at follow-up evaluations (p <0.05 for all comparisons). At presentation, stroke-VM had worse mRS than the AVF-VM (p <0.05). However, this difference was not sustained at follow up. Similarly, stroke-VM had worse ASIA scores than AVF-VM at onset (p <0.05) but there was no significant difference at follow-up. Factors associated with worse prognosis (mRS>3 at follow up) included presence of longitudinally extensive lesions (>3 spinal levels) on initial MRI [OR 2.8 (CI 1.31-6.0)], rapid progression of initial symptoms (<48 hours to nadir) [OR 3.85 (CI 1.42-10.4)] for cases of VM and pleocytosis with WBC > 50 in CSF [OR 3.3 (CI 1.13-9.58)] for IM cases.

Conclusions VM lead to worse functional outcomes compared to IM. Worse disability was predicted by presence of more extensive lesions, rapid progression of symptoms and CSF pleocytosis. Understanding the differences in prognosis in different types of myelopathies is important to appropriately counsel patients.

Authors/Disclosures
Maria A. Garcia-Dominguez, MD (UMass Memorial Medical Center) PRESENTER	Dr. Garcia-Dominguez has received personal compensation for serving as an employee of Genentech.
Paula Barreras, MD (Cedars-Sinai Medical Center)	Dr. Barreras has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Barreras has received research support from Foundation for Sarcoidosis Research. The institution of Dr. Barreras has received research support from American Academy of Neurology.
Carlos A. Pardo-Villamizar, MD (Johns Hopkins U, Med Dept of Neurology)	The institution of Dr. Pardo-Villamizar has received research support from National Institutes of Health. The institution of Dr. Pardo-Villamizar has received research support from Bart McLean Fund for Neuroimmunology Research .