Neuroepidemiology of transverse myelitis and its etiologies in Latin America: A systematic review and meta-analysis.

BACKGROUND AND

OBJECTIVES

Transverse myelitis (TM) is a rare neuro-inflammatory condition of the spinal cord that can cause chronic and debilitating symptoms reducing quality of life. TM is understudied in developing regions worldwide, particularly in Latin America and the Caribbean (LAC), where the prevalence of TM is unknown. Etiologies of TM are variable, but certain infectious, autoimmune or nutritional abnormalities may be more common in LAC with differing estimated prevalences of these etiologies. Given the paucity of data available on TM in LAC, we conducted a systematic review of the literature and meta-analysis to estimate the prevalence of TM and its etiologies in LAC.

METHODS

We conducted a comprehensive literature search in English, Spanish and Portuguese language databases for TM studies in LAC that included at least ≥ 5 cases of TM, published after 2010. We extracted data on TM frequency, etiologies, and diagnostic tools utilized for the diagnosis from each included article. A meta-analysis was conducted to estimate the proportion of TM and various TM etiologies across articles.

RESULTS

No studies were found that reported the prevalence of TM in LAC or in an individual country. A total of 99 studies were included, with autoimmune (MS, NMO/NMOSD) and infectious etiologies (HTLV-1, arboviruses) most reported. Brazil (53 studies) had the most studies on TM, followed by Mexico (16) and Argentina (15). A total of 26,992 people were included in the meta-analysis, from which the estimated proportion of TM in LAC based on all included studies was 0.47 (95%CI 0.39-0.56) using a random effects model. The utility of MRI spine, lumbar puncture, and disease-specific serological/CSF markers together to diagnose TM was utilized in only 18% of studies.

DISCUSSION: This review highlights important gaps in identifying the community prevalence of TM in LAC with no articles examining the disease's specific frequency. By understanding the epidemiology of TM, its associated etiologies, and barriers to its diagnosis in LAC, there is potential to improve treatment access and disability outcomes for those in the region affected by the disease.