Is methyl prednisolone useful in acute transverse myelitis?

Study design: Hospital based observational study. Objectives: To evaluate the role of methyl prednisolone (MPS) in the manage ment of acute transverse myelitis (ATM). Methods: Twenty-one patients with ATM were included in a prospective hospit al based study during 1992-1997. All the patients underwent neurological ex amination, spinal MRI, somatosensory and motor evoked potentials of both up per and lower limbs and concentric needle EMG study. Twelve consecutive pat ients did not receive MPS therapy who were managed during 1992-1994 and nin e consecutive patients during 1995-1997 received MPS therapy in a dose of 5 00 mg i.v. for 5 days. The clinical and neurophysiological studies were rep eated 3 months later. The outcome was defined on the basis of Barthel index (BI) score at the end of 3 months into good (BI greater than or equal to 1 2) and poor (BI<12). Results: The age of NIPS group was 25.5 years (range 12-42) and three were females. The age of non MPS group was 33.5 years (range 16-70) and two were females. In the MPS group 33% had poor outcome compared to 67% in the non MPS group. In the MPS group mean admission BI score was 7.3 which improved to 14.6 after MPS therapy. In the non MPS group, the admission BI score was 3.2 which improved to 9.6 at 3 month follow-up. In patients with complete paraplegia, evidence of denervation on EMG and unrecordable central motor c onduction time to lower limb and tibial SEP were associated with poor outco me irrespective of NIPS treatment. Global test statistics did not suggest a beneficial role of MPS therapy in the outcome of ATM. Conclusion: Our results do not suggest a beneficial role of methyl predniso lone on the 3 month outcome of ATM.