It is important, especially in adolescents, to differentiate TM from MS and Guillain-Barre. In MS symptoms are more likely separated by time, with “attacks” and a relapsing and remitting presentation. MS patients typically present with numbness and weakness in more than one extremity. In Guillain-Barre syndrome the presentation may be similar to TM in that there is weakness in the lower extremity, areflexia, and a possible viral illness precedent. However, a dermatome localization of sensory loss on neurologic exam can differentiate between a spinal cord lesion and a peripheral nerve etiology.
Treatment for TM symptoms is nonspecifi c. If a specific etiology is found then specific treatment should be rendered, otherwise one must rule out infectious or systemic inflammatory disorders. Pharmacologic treatment commonly includes high dose steroids, for example methylprednisone 1 g IV daily for 3–5 days followed with an
oral steroid taper. The evidence in the literature supporting this therapeutic approach includes mostly small studies with inconsistent results. In addition, small, uncontrolled or pilot studies have demonstrated that cyclophosphamide, azathioprine and plasmapheresis alone or in addition to corticosteroids may improve outcomes. Larger scale randomized, blinded, and controlled studies are required to more clearly define the most safe and efficacious treatment for this uncommon pediatric diagnosis.
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