What is Transverse Myelitis?
Transverse myelitis, also known as TM, is a rare neurological condition that causes inflammation in the spinal cord. It is part of a collection of inflammatory diseases including ADEM (acute disseminating encephalomyelitis) and Devic’s disease (also known as NMO).
What causes transverse myelitis?
The cause of transverse myelitis is not fully understood. However, experts have identified a number of possible causative factors, including:
- Infections: viral infections that affect the respiratory system and the gastrointestinal tract may increase the risk of transverse myelitis. In most cases, symptoms tend to occur once the infection has cleared up. Viral infections (including herpes and West Nile virus) may have a direct impact on the spinal cord or trigger an autoimmune response that involves the spinal cord.
- Parasites: very rarely, it is possible for parasites to invade the spinal cord, causing damage to the protective myelin.
- Multiple sclerosis (MS): MS is a neurological disorder that occurs when the body’s immune system starts to attack healthy myelin tissue surrounding the brain and spinal cord. In some cases, transverse myelitis can be an early sign of MS. It can also be demonstrative of a relapse following a period of remission. Usually, only one side of the body is affected.
- Devic’s disease (also known as neuromyelitis optica): this disorder causes damage to the protective myelin surrounding the spinal cord and the nerves in the eye that send information to and from the brain. In this case, both sides of the body are usually affected.
- Autoimmune disorders: autoimmune disorders, including lupus and Sjogren’s syndrome, may increase the risk of transverse myelitis.
- Vaccinations: rarely, vaccinations have been identified as a cause of transverse myelitis.
How is transverse myelitis diagnosed?
A diagnosis is made based on clinical symptoms, physical examination, medical history and the findings of tests, which may include:
- MRI scan (magnetic resonance imaging): images can highlight inflammation in the spinal cord and indicate other potential causes, such as abnormalities affecting the blood vessels
- Lumbar puncture (also known as spinal tap): this test involves removing and analysing a sample of cerebrospinal fluid from the spinal column using a very fine needle. Tests may indicate high levels of white blood cells and specific proteins symptomatic of transverse myelitis.
- Blood tests: blood tests can help to detect antibodies associated with NMO. If this is the case, there may be a heightened risk of transverse myelitis.
What are the symptoms?
In most cases, the symptoms of transverse myelitis come on over the course of a few hours and it is rare for symptoms to progress over a prolonged period of time. Symptoms may affect one or both sides of the body and include:
- Pain: pain tends to originate in the neck or back and radiate around the body. You may experience very sharp, stabbing pains
- Tingling, burning sensations, loss of feeling and coldness
- Weakness in the upper and lower limbs
- Changes in bowel habits and bladder weakness
It is common for transverse myelitis to occur in just one acute episode. However, if symptoms persist, complications can develop, including chronic pain, muscle spasms, an increased risk of anxiety or depression, impaired sexual function and stiffness.
Treatment for transverse myelitis
Treatment options for transverse myelitis include:
- Steroid medication: this is given intravenously following diagnosis and treatment may last for several days
- Pain relief drugs
- Plasma exchange therapy: this may be recommended if the patient does not respond positively to steroids. It involves removing the blood plasma.
- Antiviral medication: this may be prescribed in cases where transverse myelitis is linked to a viral infection
Medication may also be recommended for any complications that arise, such as depression or changes in bowel habits.
Physiotherapy and occupational therapy can also help to improve strength, flexibility and mobility and enable you to live more comfortably at home.
What is the outlook?
The outlook is generally fairly positive, although recovery can take a long time. Most people will experience at least moderate recovery following a bout of transverse myelitis. However, it can take several months. The prognosis for neuromyelitis optica is less positive and individuals are likely to develop at least mild disabilities.