Transverse Myelitis (TM): Symptoms, Causes, Treatment

What are the symptoms of transverse myelitis?

Transverse myelitis is a rare neurological condition that involves inflammation of both sides of a section of the spinal cord, disrupting nerve signals and potentially leading to a range of symptoms. The symptoms of transverse myelitis can develop rapidly over a few hours or gradually over days to weeks. Key symptoms include:

Weakness in the Arms or Legs: Muscle weakness, often more pronounced in the legs, is common. It may start as a feeling of heaviness or clumsiness and can progress to partial or complete paralysis in severe cases.
Sensory Changes: Patients may experience numbness, tingling, or a burning sensation, typically beginning in the feet and moving upwards. Some people also report increased sensitivity to touch or an abnormal sensation like burning or coldness.
Pain: Sudden and severe pain in the lower back, neck, or between the shoulder blades is a common early symptom. The pain may radiate to the arms, legs, or chest.
Bladder and Bowel Dysfunction: Transverse myelitis often affects the nerves that control the bladder and bowels, leading to urinary urgency, retention, incontinence, or constipation.
Muscle Spasms: Muscle stiffness or involuntary spasms (spasticity) can occur, often affecting the legs.
Paralysis: Depending on the level and severity of the spinal cord involvement, partial or complete paralysis may develop in the affected limbs.
Autonomic Symptoms: Some patients may experience issues with blood pressure regulation, abnormal sweating, or problems with body temperature control due to the disruption of autonomic nervous system functions.

Symptoms can vary in severity depending on the extent and location of the inflammation within the spinal cord. Early recognition and treatment are critical for improving outcomes and preventing long-term complications.

What are the causes of transverse myelitis?

Transverse myelitis is caused by inflammation of the spinal cord, which disrupts the normal functioning of the nerve fibers that transmit signals from the brain to the rest of the body. The inflammation can be triggered by a variety of factors, including:

Autoimmune Diseases: Transverse myelitis can occur when the body’s immune system mistakenly attacks its own tissues. Conditions like multiple sclerosis, neuromyelitis optica (NMO), and systemic lupus erythematosus can cause this kind of immune response.
Infections: Viral, bacterial, fungal, or parasitic infections can trigger transverse myelitis. Some common infections linked to the condition include herpes viruses (like herpes simplex, varicella-zoster, and Epstein-Barr), enteroviruses, HIV, and Lyme disease. In some cases, the inflammation may occur after the infection has resolved.
Post-Infectious or Post-Vaccination Immune Response: Sometimes, transverse myelitis can develop as an immune reaction after an infection or, less commonly, following vaccination. The immune system may become overactive and attack the spinal cord, even after the initial trigger is no longer present.
Other Inflammatory Disorders: Conditions like sarcoidosis, which causes clusters of inflammatory cells in different parts of the body, can also lead to transverse myelitis.
Paraneoplastic Syndrome: Rarely, transverse myelitis can occur as a result of a paraneoplastic syndrome, where the immune system reacts to cancer cells in the body and mistakenly attacks the spinal cord.
Idiopathic Causes: In many cases, the exact cause of transverse myelitis remains unknown. When no underlying cause is identified, it is referred to as idiopathic transverse myelitis.

Understanding the underlying cause of transverse myelitis is important for determining the best course of treatment and predicting the potential for recovery.

What is the treatment for transverse myelitis?

The treatment for transverse myelitis focuses on reducing inflammation, managing symptoms, and addressing the underlying cause if known. Treatment strategies can vary based on the severity of symptoms and the underlying condition contributing to the inflammation. Here’s a general approach:

1. Corticosteroids

High-Dose Corticosteroids: Medications such as intravenous (IV) steroids (e.g., methylprednisolone) are often used to reduce spinal cord inflammation and swelling. This is typically administered for a few days to help alleviate symptoms and improve recovery.

2. Plasma Exchange (Plasmapheresis)

Plasma Exchange: For patients who do not respond to corticosteroids or have severe symptoms, plasma exchange may be used. This procedure involves removing blood from the body, separating and discarding the plasma (which contains inflammatory antibodies), and returning the cleaned blood to the body.

3. Treatment of Underlying Conditions

Addressing the Root Cause: If transverse myelitis is secondary to an underlying condition such as an autoimmune disorder, infection, or cancer, treating that condition is crucial. This might include antibiotics, antivirals, immunosuppressants, or other specific therapies.

4. Symptom Management

Pain Management: Analgesics and medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or neuropathic pain agents (e.g., gabapentin) can help manage pain associated with transverse myelitis.
Muscle Relaxants: Medications like baclofen or tizanidine may be used to control muscle spasticity and spasms.
Bladder and Bowel Management: Medications and lifestyle changes may help manage urinary and bowel dysfunction, such as using catheterization or medications to control bladder function.

5. Physical Therapy and Rehabilitation

Physical Therapy: A tailored rehabilitation program is important for improving mobility, strength, and function. Physical therapists work with patients to develop exercises that help with walking, muscle strengthening, and coordination.
Occupational Therapy: Occupational therapy can assist with daily living activities and adaptations to help individuals maintain independence.

6. Supportive Care

Psychological Support: Coping with a chronic condition can be challenging, and psychological support or counseling may be beneficial for managing stress, anxiety, or depression related to the condition.

7. Follow-Up Care

Regular Monitoring: Ongoing follow-up with healthcare providers is essential to monitor recovery, adjust treatments as needed, and address any new or persistent symptoms.

Early diagnosis and treatment of transverse myelitis are critical for improving outcomes and minimizing long-term disability. The management plan is highly individualized, depending on the patient’s specific situation and the response to initial treatments.