Transverse Myelitis

Transverse myelitis is a rare neurological disorder characterized by inflammation across one section of the spinal cord. This inflammation damages the myelin, the protective covering of nerve fibers, disrupting communication between the brain and the rest of the body. It can lead to symptoms such as muscle weakness, sensory changes, and problems with bladder or bowel control.

What is Transverse Myelitis?

Transverse myelitis is a rare neurological condition where inflammation occurs across one segment of the spinal cord. This inflammation damages the myelin, a fatty substance that insulates nerve fibers, disrupting communication between the brain and the body. It can lead to symptoms like muscle weakness, numbness, and problems with bladder or bowel control.

Transverse myelitis is an inflammation of the spinal cord. The term "transverse" means the inflammation extends across the width of the spinal cord, while "myelitis" refers to inflammation of the spinal cord itself (MedlinePlus, Mayo Clinic). This inflammation damages the myelin, which is the protective sheath around nerve fibers. It can also harm the nerve cells themselves. This interference disrupts the nerve signals that travel from the brain to the rest of the body and back again (Mayo Clinic, MedlinePlus). The condition can affect any part of the spinal cord, but it often occurs in the thoracic, or mid-back, region (Mayo Clinic). Symptoms can develop very quickly, sometimes over just a few hours or days, or more gradually over several weeks (Mayo Clinic, MedlinePlus). Transverse myelitis is considered a rare condition. It affects approximately 1,400 new people in the U.S. each year (MedlinePlus).

Symptoms

Symptoms of transverse myelitis usually develop quickly, often over hours or days, and can include muscle weakness in the arms or legs, numbness, tingling, or pain. Many people also experience problems with bladder and bowel control. The specific symptoms depend on which part of the spinal cord is affected.

Symptoms of transverse myelitis often appear suddenly, sometimes within hours, or they can develop over one to four weeks (Mayo Clinic, MedlinePlus). The severity of symptoms can vary widely. There are four classic signs and symptoms (Mayo Clinic): * **Weakness in your arms or legs:** This often begins in the legs and can progress to cause partial paralysis (paresis) or complete paralysis (paraplegia). You might feel your legs are heavy, or you may stumble (Mayo Clinic, MedlinePlus). * **Pain:** Many people experience sharp, shooting pain that can wrap around the torso, legs, or arms. It often starts suddenly in the lower back (Mayo Clinic, MedlinePlus). * **Sensory changes:** You might feel numbness, tingling, coldness, or a burning sensation. Some people have heightened sensitivity to light touch or feel as if they are wearing tight bands around their torso or legs (Mayo Clinic, MedlinePlus). * **Bladder and bowel problems:** This can include an increased urge to urinate, incontinence (loss of bladder control), difficulty urinating, or constipation (Mayo Clinic, MedlinePlus). Other possible symptoms include headaches, fever, loss of appetite, muscle spasms, and sexual dysfunction (MedlinePlus).

Causes & risk factors

The exact cause of transverse myelitis is often unknown, but it is believed to be an autoimmune condition where the immune system mistakenly attacks the spinal cord. It can also be triggered by infections, other inflammatory diseases like multiple sclerosis, or certain vaccinations. Anyone can develop it, regardless of age or sex.

In many cases, the exact cause of transverse myelitis is not known (Mayo Clinic, MedlinePlus). However, it is often thought to be an autoimmune condition, meaning your immune system mistakenly attacks your own spinal cord (Mayo Clinic, MedlinePlus). Transverse myelitis can also be triggered by or associated with several other conditions: * **Infections:** Various infections can precede or trigger transverse myelitis. These include viral infections (such as herpes viruses, HIV, Zika, or enteroviruses), bacterial infections (like Lyme disease, syphilis, or tuberculosis), fungal infections, or parasitic infections (Mayo Clinic, MedlinePlus). * **Inflammatory diseases:** Transverse myelitis can occur as part of other inflammatory or autoimmune conditions. These include multiple sclerosis (MS), where transverse myelitis can be the first sign of the disease (Mayo Clinic). About 10-20% of people who have transverse myelitis later develop MS (MedlinePlus). Other associated conditions include neuromyelitis optica (NMO), systemic lupus erythematosus (lupus), Sjögren's syndrome, and sarcoidosis (Mayo Clinic). * **Other causes:** In rare instances, certain vaccinations, such as those for hepatitis B, measles-mumps-rubella, or diphtheria-tetanus, have been linked to transverse myelitis (Mayo Clinic). Transverse myelitis can affect people of any age, sex, or race (Mayo Clinic, MedlinePlus). There are two peak age ranges for diagnosis: between 10 and 19 years old, and between 30 and 39 years old (MedlinePlus). Beyond the underlying conditions mentioned, there are no specific risk factors identified (Mayo Clinic).

How it's diagnosed

Diagnosing transverse myelitis involves ruling out other conditions that cause similar symptoms. Doctors typically perform a physical exam and neurological assessment, followed by an MRI of the spine to look for inflammation. A lumbar puncture (spinal tap) to analyze cerebrospinal fluid can also help confirm the diagnosis and identify potential causes.

Diagnosing transverse myelitis requires a thorough evaluation to distinguish it from other conditions that can cause similar symptoms. Your doctor will typically start with a physical exam and a neurological assessment to check your reflexes, muscle strength, sensation, and coordination (Mayo Clinic). Key diagnostic tests include: * **Magnetic resonance imaging (MRI):** An MRI of the spine is essential. It can show inflammation in the spinal cord and help rule out other problems like spinal cord compression, tumors, or herniated discs (Mayo Clinic, MedlinePlus). * **Lumbar puncture (spinal tap):** During this procedure, a needle is used to collect a small sample of cerebrospinal fluid (CSF) from the spinal canal. In people with transverse myelitis, the CSF may show an increased number of white blood cells or elevated protein levels. This test can also help identify infections or specific antibodies (Mayo Clinic, MedlinePlus). * **Blood tests:** Blood tests can help identify infections, autoimmune conditions, or specific antibodies associated with conditions like neuromyelitis optica (Mayo Clinic, MedlinePlus). It is important for doctors to differentiate transverse myelitis from other conditions that mimic its symptoms, such as multiple sclerosis, neuromyelitis optica, spinal cord compression, or vitamin B-12 deficiency (Mayo Clinic).

Treatment options

Treatment for transverse myelitis focuses on managing symptoms, reducing inflammation, and preventing further damage. High-dose intravenous corticosteroids are often used to decrease inflammation. Other treatments may include plasma exchange, pain medications, and therapies to manage specific symptoms like muscle spasms or bladder dysfunction.

Treatment for transverse myelitis aims to stop the inflammation, manage symptoms, and help you recover function. Initial treatments during the acute phase often include: * **Intravenous corticosteroids:** High doses of corticosteroids, such as methylprednisolone, are given through a vein. These medications help reduce the inflammation in the spinal cord and are a common first-line treatment (Mayo Clinic, MedlinePlus, Cochrane Library). * **Plasma exchange (plasmapheresis):** If corticosteroids are not effective, plasma exchange may be used. This procedure removes plasma, the liquid part of your blood, and replaces it with new plasma or a plasma substitute. This helps remove harmful antibodies that may be attacking the spinal cord (Mayo Clinic, MedlinePlus, Cochrane Library). * **Intravenous immunoglobulin (IVIG):** In some cases, intravenous immunoglobulin may be used. This involves giving healthy antibodies to help calm the immune system (Mayo Clinic). Beyond these acute treatments, managing specific symptoms is also crucial: * **Pain medications:** Over-the-counter pain relievers, prescription medications for nerve pain (neuropathic pain) like gabapentin or pregabalin, and muscle relaxants for muscle spasms may be prescribed (Mayo Clinic, MedlinePlus). * **Other medications:** Drugs can help manage bladder or bowel dysfunction, depression, or sexual dysfunction (Mayo Clinic, MedlinePlus). Rehabilitation is a vital part of recovery. Physical therapy helps regain strength and coordination, occupational therapy assists with daily activities, and sometimes speech therapy is needed. Rehabilitation often begins during the acute phase of the illness (Mayo Clinic, MedlinePlus).

Recovery & outlook

Recovery from transverse myelitis varies greatly among individuals, with most improvement occurring within the first three to six months. About one-third of people experience good recovery, one-third have moderate disability, and one-third have severe disability. Long-term outcomes depend on the severity of the initial attack and how quickly treatment began.

The recovery process from transverse myelitis is highly individual and can vary significantly from person to person. Most improvement typically occurs within the first three to six months after symptoms begin, but recovery can continue for up to two years (Mayo Clinic, MedlinePlus). Outcomes are generally categorized into three groups (Mayo Clinic, MedlinePlus): * **Good recovery:** About one-third of people experience a good or full recovery, with few or no lasting symptoms. * **Moderate disability:** Approximately one-third of individuals have moderate disability. This might mean they experience some difficulty walking, ongoing bladder or bowel problems, or persistent numbness. * **Severe disability:** About one-third of people face severe disability, potentially requiring a wheelchair and needing assistance with daily activities. Several factors can influence the long-term outlook. A rapid onset of symptoms, particularly within 24 hours, is often associated with a poorer prognosis (MedlinePlus). Conversely, severe back pain at the onset may indicate a better chance of recovery (MedlinePlus). Complete loss of function, such as paralysis (paraplegia), or severe sensory loss at the beginning of the illness often suggests a less favorable outcome (Mayo Clinic). Starting treatment early can also improve recovery chances (Mayo Clinic). Some individuals, especially those with an underlying condition like multiple sclerosis or neuromyelitis optica, may experience recurrent episodes of transverse myelitis (Mayo Clinic).

When to see a doctor

You should seek immediate medical attention if you experience new, unexplained symptoms such as sudden weakness or numbness in your arms or legs, severe back pain, or problems with bladder or bowel control. These symptoms could indicate transverse myelitis or another serious neurological condition requiring urgent diagnosis and treatment to prevent further damage.

It is crucial to seek immediate medical attention if you experience any sudden onset of symptoms that might suggest transverse myelitis. These include: * Sudden weakness or paralysis in your arms or legs (Mayo Clinic, MedlinePlus). * New or rapidly spreading numbness, tingling, or other sensory changes (Mayo Clinic, MedlinePlus). * Severe back pain that radiates down your legs or wraps around your torso (Mayo Clinic, MedlinePlus). * New or worsening problems with bladder or bowel control (Mayo Clinic, MedlinePlus). Early diagnosis and prompt treatment are very important. Receiving timely medical help can help minimize damage to the spinal cord and improve your chances of a better recovery (Mayo Clinic). Do not delay seeking care for these types of symptoms.

Frequently asked questions

Is transverse myelitis contagious?

No, transverse myelitis is not contagious. It is an inflammatory condition of the spinal cord, often triggered by an autoimmune response or an infection, but it cannot be spread from person to person.

Can transverse myelitis be cured?

There is no specific cure for transverse myelitis. Treatment focuses on managing the acute inflammation, relieving symptoms, and supporting recovery through rehabilitation. Some people experience full recovery, while others live with varying degrees of disability.

What is the difference between transverse myelitis and multiple sclerosis (MS)?

Transverse myelitis is an isolated episode of spinal cord inflammation. Multiple sclerosis is a chronic, progressive autoimmune disease that affects the brain and spinal cord, causing multiple episodes of inflammation (lesions) over time. Transverse myelitis can sometimes be the first symptom of MS.

How long does a transverse myelitis attack last?

The acute phase of transverse myelitis, where symptoms develop and worsen, typically lasts from hours to several weeks. Recovery usually begins within weeks to months after the attack, with most improvement seen in the first three to six months.

Will I walk again after transverse myelitis?

The ability to walk again varies greatly. About one-third of people with transverse myelitis experience a good or full recovery, often regaining the ability to walk independently. Another third may have moderate disability, while the remaining third experience severe disability and may require mobility aids.

Are there any long-term complications of transverse myelitis?

Yes, long-term complications can include persistent muscle weakness, spasticity (muscle stiffness), chronic pain, numbness, bladder and bowel dysfunction, and depression. The severity of these complications varies widely among individuals.

Sources

• MedlinePlus — Transverse Myelitis
• Mayo Clinic — Transverse Myelitis
• Cochrane Library — Transverse Myelitis