Clinical, radiological, and immunological profile of transverse myelitis in children: Experience from the largest public-sector paediatric Hospital in Sindh.

Abstract

Objective: To evaluate the clinical, radiological, and immunological profiles of paediatric TM patients at a tertiary care hospital in Karachi, Pakistan, and to identify the prevalence of comorbid Vitamin B12 and folate deficiencies. Study Design: Descriptive Cross-sectional study. Setting: Department of Neurology, National Institute of Child Health (NICH), Karachi, Pakistan. Period: June 2023 to June 2024. Methods: Thirty-one patients aged 3 to 18 years meeting the 2002 Transverse Myelitis Consortium criteria were enrolled using non-probability consecutive sampling. Evaluation included spinal MRI, CSF analysis, serum AQP4 and MOG antibody testing, and nutritional assessments. Results: The mean age was 7 years, with a female predominance of 61.3%. Lower limb weakness and bladder dysfunction were universal (100%). Longitudinally extensive transverse myelitis (LETM), involving ≥3 vertebral segments, was observed in 64.5% of patients. CSF pleocytosis occurred in 74.2% and elevated protein in 80.6% of cases. Nutritional analysis revealed Vitamin B12 deficiency in 22.6% and RBC folate deficiency in 12.9% of the cohort. Conclusion: Paediatric TM in the Pakistani population is characterized by a high frequency of longitudinally extensive lesions and profound autonomic failure. The significant prevalence of B12 and folate deficiencies identifies a regional metabolic-inflammatory interface, suggesting that routine nutritional screening is essential for children presenting with acute myelopathy.