About Transverse Myelitis
Transverse myelitis is a neurological disorder caused by inflammation of the spinal cord. The inflammation can be caused by various factors, including infections, immune system disorders, and other inflammatory disorders.
Causes of transverse myelitis include:
- Infections: These may be viral or bacterial infections, such as herpes, Epstein-Barr virus, Lyme disease, and syphilis.
- Autoimmune disorders such as multiple sclerosis
- Other Inflammatory Disorders: Conditions like sarcoidosis and lupus can also lead to inflammation of the spinal cord and cause transverse myelitis.
- Spinal Cord Injury: Physical trauma to the spinal cord can result in inflammation and damage to the spinal cord
Non-modifiable risk factors are factors that cannot be changed or controlled. Non-modifiable risk factors of transverse myelitis include:
- Age: The risk tends to be higher in adults compared to children.
- Genetic Predispositions: Having a positive family history of transverse myelitis or other related neurological disorders may increase the risk.
Modifiable risk factors are factors that can be influenced or changed. Modifiable risk factors of transverse myelitis include:
- Smoking: Smoking is a modifiable risk factor that can increase the risk of developing transverse myelitis.
- Vitamin D Deficiency: Not getting enough vitamin D has been linked to an increased risk of developing multiple sclerosis, which in turn increases the risk of transverse myelitis.
The most common early symptoms of transverse myelitis include:
- Weakness of the legs and arms: People with transverse myelitis may experience weakness in their legs that progresses rapidly. If the myelitis affects the upper spinal cord, it can also affect the arms. This may lead to paraparesis (partial paralysis of the legs) or even paraplegia (complete paralysis of the legs), requiring the use of a wheelchair.
- Pain: Initial symptoms often include lower back pain or sharp, shooting sensations that radiate down the legs or arms, or around the torso.
- Sensory alterations: These may be burning, tickling, pricking, numbness, coldness, or tingling in the legs. Sensory loss may also occur. Abnormal sensations in the torso and genital region are also common.
As transverse myelitis progresses or reaches higher severity, other common symptoms may occur. These can include:
- Bowel and bladder dysfunction: This may present as increased frequency or urge to use the toilet, incontinence (involuntary loss of bladder control), and constipation.
- Muscle spasms
- General discomfort
- Headache
- Fever and loss of appetite
- Respiratory problems
- Sexual dysfunction
- Depression or anxiety
To diagnose transverse myelitis, healthcare providers commonly perform a series of examinations, tests, and procedures. These may include:
- Medical history: Your healthcare provider will gather information about your medical history, including any previous diagnoses or underlying health problems.
- Physical exam: During the physical exam, your healthcare provider will look for physical signs of a medical problem. This may involve routine procedures like checking your reflexes and assessing your muscle strength.
- Lab tests: Specific lab tests may be recommended to help diagnose transverse myelitis. These can include a blood draw to identify or rule out various disorders, such as HIV infection or vitamin B12 deficiency. Blood tests may also check for the presence of autoantibodies (proteins produced by cells of the immune system) associated with autoimmune disorders.
- Imaging studies: Imaging studies like magnetic resonance imaging (MRI) and computed tomography (CT) can provide valuable information for diagnosing transverse myelitis. An MRI produces cross-sectional images of tissues, including the brain and spinal cord, which can confirm the presence of a damaged area (lesion) within the spinal cord. CT scans may be used to detect inflammation in the spine.
- Clinical procedures: Depending on the information gathered and the results of other examinations, your healthcare provider may recommend clinical procedures to further evaluate transverse myelitis. These procedures can vary depending on the body system being evaluated and may include a hearing test or other specialized tests.
It's important to follow up with your healthcare provider if any symptoms worsen or change after these examinations and tests are performed. They will be able to provide you with appropriate guidance and recommendations based on your individual situation.
The goals of treatment for transverse myelitis are to manage symptoms, prevent future attacks, and improve overall quality of life. Here are the different types of treatments recommended and how they work to achieve these goals:
- Medications:
- Immunosuppressant Treatments: These medications, such as mycophenolate mofetil, azathioprine, and rituximab, are used to prevent future attacks of transverse myelitis by suppressing the immune system's activity. They aim to reduce inflammation and immune attacks on the spinal cord.
- Steroids: High-dose steroids, such as intravenous methylprednisolone, are commonly used to reduce inflammation in the spinal cord.
- Intravenous Corticosteroid Drugs: Medications like methylprednisolone or dexamethasone are given through an IV to decrease swelling and inflammation in the spine. They also help reduce immune system activity and subsequent attacks.
- Therapies:
- Rehabilitation Services: Various forms of long-term rehabilitation are available for individuals with disabilities resulting from transverse myelitis. Rehabilitation cannot reverse the physical damage caused by the condition, but it can help improve strength, functioning, and overall quality of life.
- Physical Therapy: Physical therapy focuses on retaining muscle strength and flexibility, improving coordination, reducing spasticity (muscle stiffness), regaining control over bladder and bowel function, and increasing joint movement. It helps individuals become as functionally independent as possible.
- Occupational Therapy: Occupational therapy helps individuals learn new ways to maintain or rebuild their independence in daily tasks such as bathing, dressing, meal preparation, and house cleaning.
- Assistive Devices: People with transverse myelitis may be taught to use assistive devices like wheelchairs, canes, or braces to improve mobility and independence.
- Vocational Therapy: Vocational therapy focuses on developing work skills, identifying potential employers, and assisting in job searches. Vocational therapists also help secure reasonable workplace accommodations.
- Psychotherapy: Psychotherapy provides strategies and tools to cope with stress and manage a wide range of emotions and behaviors associated with living with permanent damage.
- Therapeutic Procedures:
- Lumbar Puncture and Spinal Fluid Analysis: This procedure, also known as a spinal tap, can identify abnormal protein levels and increased white blood cells in the spinal fluid. These findings can help diagnose transverse myelitis.
- Plasma Exchange Therapy (Plasmapheresis): This procedure removes plasma (the fluid containing antibodies) from the blood and replaces it with special fluids. It aims to reduce immune system activity by removing antibodies and other proteins that contribute to inflammation.
Each treatment approach plays a crucial role in managing symptoms, preventing future attacks or complications, improving physical functioning, promoting independence in daily activities and work settings, addressing emotional well-being, and enhancing overall quality of life for individuals with transverse myelitis.
Transverse myelitis can have different presentations and outcomes depending on the individual. Here's what we know about the natural progression, complications, and treatment of transverse myelitis:
Natural Progression:
- Transverse myelitis is usually an acute illness that develops over several hours and progresses within the next few days.
- Patients typically present with weakness in their limbs and sensory disturbances.
- Autonomic involvement may lead to bowel or bladder dysfunction.
- The segment of the spinal cord where the damage occurs determines which parts of the body are affected.
- Recovery from transverse myelitis can vary, with some people experiencing minor or no residual problems, while others may have long-lasting impairments.
- The healing process can take months to years, and most recovery occurs within the first three months after the initial attack.
Complications:
- Weakness: Transverse myelitis can cause weakness in the legs and arms. Some individuals may experience partial paralysis (paraparesis) or complete paralysis (paraplegia) of the legs, requiring the use of a wheelchair.
- Pain: Lower back pain or sharp shooting sensations that radiate down the legs or arms are common initial symptoms of transverse myelitis.
- Sensory alterations: Abnormal sensations such as burning, tingling, numbness, or coldness may occur in the legs and torso. Sensory loss can also be experienced.
- Bladder and bowel dysfunction: Transverse myelitis can lead to urinary retention, disturbances in defecation, and other bladder-related issues.
It's important to note that individual experiences with transverse myelitis can vary greatly. It is always recommended to consult with a healthcare professional for proper diagnosis, treatment options, and management strategies tailored to each person's specific needs.