TRANSVERSE MYELITIS: CURRENT THERAPEUTIC STRATEGIES AND PERSPECTIVES ON NEUROLOGICAL RECOVERY

Abstract

Transverse myelitis (TM) is a rare neuroinflammatory disorder of the spinal cord, characterized by acute onset motor, sensory, and autonomic dysfunction. This narrative review addresses current therapeutic strategies and recovery prospects. The etiology of TM is varied, and diagnostic differentiation—through serology (anti-AQP4 and anti-MOG antibodies) and MRI—is crucial between idiopathic, post-infectious forms and those associated with autoimmune demyelinating diseases, such as Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorder (NMOSD), and MOG antibody-associated disease (MOGAD). Treatment of the acute phase is aggressive, using high-dose intravenous corticosteroids as first-line therapy. For refractory or severe cases, plasmapheresis (PLEX) or intravenous immunoglobulin (IVIg) are second-line therapies. Long-term preventive treatment is mandatory in NMOSD (high risk of relapse), but in MOGAD (frequently monophasic) it is reserved for recurrent cases. The prognosis is variable; although one-third of patients recover well, MOGAD tends to have better motor recovery than NMOSD.