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A rare neurological disorder known as transverse myelitis (TM) is caused by an inflammation on both sides of one part of the spinal cord. The insulating substance protecting nerve cell fibers (myelin) is often harmed by this neurological condition. The myelin sheath, which protects the spinal cords nerve cells, is damaged as a result of inflammation. This interferes with the communication between the spinal nerves and the rest of the body, leading to problems like loss of feeling, uncontrollable movement, and incontinence (bladder and bowel.)
Transverse myelitis can be caused by a variety of factors, including infections and immune system disorders that harm the body’s tissues. Additionally, conditions that affect myelin, such as multiple sclerosis, have the potential to lead to transverse myelitis. Transverse myelitis is frequently mistaken with other condition, such as a spinal cord stroke, which need different types of treatment.
The treatment of transverse myelitis usually involves a combination of medication and rehabilitative therapy. Most patients with transverse myelitis experience at least partial recovery. However, in severe cases, individuals may be left with significant disability. While some people are able to overcome the symptoms and challenges of transverse myelitis, others may not fully recover.
Symptoms
Transverse myelitis signs and symptoms commonly appear over a short period of time (a few hours to a few days) and can steadily worsen over a period of weeks. The symptoms of transverse myelitis can quickly worsen in severity. Treatment can help alleviate or completely eliminate these symptoms for some individuals, but for others, it may lead to long-term complications.
Typically, transverse myelitis symptoms appear on one side of the body (common with people with multiple sclerosis), but they might also affect both sides of the body below the damaged spinal cord.
Signs and symptoms for transverse myelitis may include the following:
- Pain: Pain often begins quickly in the lower back and may radiate to the arms, chest, abdomen, legs, or arms, depending on the location of the damaged spinal cord. The type of pain experienced can vary.
- Abnormal sensations: Patients may experience numbness, tingling, coldness, or burning sensations. Certain individuals may be more susceptible to experiencing discomfort from light clothing touch or extreme temperatures, whether they are high or low. The chest, abdomen, or legs may feel as though they are being tightly wrapped.
- Weakness: Some people feel their legs are heavy, or they stumble or drag one foot. Some could get severe paralysis or even total weakness. Leg weakness that develops quickly in TM patients is possible. The arms are also affected by the inflammation if it affects the upper spinal cord.
- Bladder and bowel problems. This may include constipation, frequent urination, urine incontinence, or difficulty urinating
- Others: Headache, loss of appetite, fever, or respiratory problems may also be present.
If you are showing symptoms of transverse myelitis such as sensory issues, weakness, or bladder/bowel dysfunction, it’s essential to contact your doctor immediately or seek emergency medical care. These symptoms can be caused by various neurological disorders, including spinal cord compression, which requires urgent surgical attention.
Less frequently, impaired blood circulation can result in a spinal cord stroke. This condition may occur due to a blocked blood vessel that supplies blood to the spinal cord, and it can be a result of aortic surgery or increased clotting of the blood. It is crucial to obtain a timely diagnosis and receive appropriate treatment for this condition.
Causes
The exact cause of transverse myelitis remains unknown. Transverse myelitis is typically caused by inflammation of the spinal cord, which can result from an infection with bacteria, viruses, or fungi. This inflammatory disorder generally presents itself after the infection has been resolved.
There are several possible factors that can trigger inflammation and lead to transverse myelitis (TM). The following are known to cause transverse myelitis:
- Viral infection: Viruses associated with transverse myelitis such as herpes viruses (chicken pox, or shingle), Epstein-Barr, HIV, influenza, Hepatitis B, and rubella virus (measles). Immune responses can be brought on by other viruses without the spinal cord being directly harmed.
- Bacterial infections: Bacteria associated with transverse myelitis include Lyme disease, syphilis, tuberculosis, diphtheria, pertussis, and tetanus. Transverse myelitis can also be brought on by bacterial pneumonia, gastroenteritis, and skin diseases. Occasionally, the spinal cord may contract parasitic and fungi infections.
- Other conditions: Transverse myelitis is occasionally the initial sign of an immune- or autoimmune-mediated condition affecting the central nervous system, such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). Transverse myelitis appears to be induced by various inflammatory disorders, including the following:
- Multiple sclerosis: a condition when the immune system destroys the myelin sheathing nerves in the brain and spinal cord. Transverse myelitis may signal the onset of multiple sclerosis or a relapse. Multiple sclerosis symptoms associated with transverse myelitis typically affect only one side of the body.
- Neuromyelitis optica (Devic’s disease): a condition that affects the spinal cord, the nerve in the eye that sends information to the brain and causes inflammation and myelin loss in those areas. Neuromyelitis optica-related transverse myelitis frequently affects both sides of the body.
The patient may also experience transverse myelitis and signs of the optic nerve’s myelin damage, such as pain when moving the eye and brief visual loss. Transverse myelitis symptoms may also occur in conjunction with this or alone. While some patients with neuromyelitis optica experience recurring episodes of transverse myelitis, they may not necessarily have any issues related to their eyes. - Autoimmune disorders: These conditions include Sjogren’s syndrome, which causes extreme dryness of the lips and eyes, and lupus, which can damage multiple systems. Neuromyelitis optica may present as transverse myelitis linked to an autoimmune disease. In individuals with other autoimmune disorders, neuromyelitis optica is more common. (1)
- Vaccines: There have been reports of transverse myelitis cases occurring after vaccination for various diseases, including hepatitis B, measles-mumps-rubella, diphtheria-tetanus-pertussis, and COVID-19. These cases have been reported to occur within a range of two days to three months after vaccination.
Although the exact cause of this reaction is unknown, one theory suggests that vaccination may trigger an autoimmune response. However, it is important to note that extensive research has confirmed the safety of vaccinations, and any potential link to transverse myelitis may be coincidental or a very rare complication at worst.
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- Sarcoidosis: The spinal cord and optic nerve can become inflamed as a result of this condition. Sarcoidosis symptoms may resemble those of neuromyelitis optica, but they usually take longer to appear. The exact cause of sarcoidosis remains unknown.
Diagnosis
Diagnostic tests include the following in order to determine whether the spinal cord is not being affected by inflammation by ruling out conditions like a spinal tumor, ruptured disc, or compression brought on by an abscess, and determine whether spinal cord inflammation is present:
- Physical examination: When a patient exhibits symptoms of transverse myelitis, their healthcare provider will perform a physical examination and review their medical history. The healthcare provider will also evaluate the patient’s nerve function through a clinical assessment and may recommend various tests.
- Blood tests: This could involve a test that looks for antibodies linked to neuromyelitis optica, a condition that causes inflammation in both your spinal cord and the nerve that runs through your eye. Individuals who test positive for antibodies are at a higher risk of experiencing multiple transverse myelitis attacks and require treatment to prevent further occurrences.
- Magnetic resonance imaging (MRI): MRI is a non-invasive medical examination that utilizes a strong magnetic field, radio waves, and a computer to generate highly detailed images of the internal organs and structures of the body. It is a painless procedure that can provide precise information about any abnormalities or conditions within the body. In some cases, two spinal MRIs may be necessary – one with the use of gadolinium contrast and one without – to help your healthcare provider distinguish between compressive and non-compressive lesions.
- Lumbar puncture (spinal tap): utilizes a needle to draw a little amount of the protective fluid that surrounds the spinal cord and brain, known as cerebrospinal fluid (CSF). The CSF sample is then examined in a lab to look for abnormally high white blood cell or IgG index levels or the presence of oligoclonal IgG bands specific to the CSF. There are several of these inflammatory markers in TM.
CSF from some transverse myelitis patients may contain excessive amounts of white blood cells or immune system proteins that signify inflammation. Testing for certain malignancies and viral diseases can also be done on spinal fluid.
Treatment
There are several treatments for transverse myelitis signs and symptoms that includes:
- Intravenous steroids: To alleviate the inflammation in your spinal column, it’s likely that you’ll be given steroids intravenously in your arm for several days. Steroids are effective in reducing the inflammation.
- Intravenous immune globulin (IVIG): This treatment uses injectable antibodies to treat the disease (intravenously). By attaching to the antibodies that may be the cause of the TM, this therapy can be utilized to help lessen the inflammatory response in your spinal cord.
- Plasma exchange therapy: In cases where intravenous steroid treatment is ineffective for a patient, plasma exchange therapy may be necessary to cleanse the blood. This process removes the proteins and antibodies that are believed to be responsible for the inflammatory response. This involves extracting the straw-colored fluid called plasma, which contains blood cells, and substituting it with specialized fluids.
- Viral medication: Antiviral drugs may be used to treat the virus in some patients with viral spinal cord infections.
- Pain medication: A typical side effect of transverse myelitis is chronic pain. Common painkillers like acetaminophen (Tylenol, among others), ibuprofen (Advil, Motrin IB, among others), and naproxen sodium may help with muscle discomfort (Aleve.) Sertraline (Zoloft), an antidepressant, and gabapentin (Neurontin, Gralise, or pregabalin, an anticonvulsant, are two medications that can be used to alleviate nerve pain (Lyrica).
- Medications for other complications: To manage symptoms such as muscle rigidity, bowel or urinary incontinence, depression, or other complications related to transverse myelitis, healthcare providers may prescribe additional medications as needed.
- Preventative drugs for transverse myelitis attacks: To reduce the risk of further episodes of transverse myelitis or the development of optic neuritis, individuals with antibodies associated with neuromyelitis optica require ongoing treatment with corticosteroids and/or immunosuppressants.
- Other therapies: Other treatments that focus on long-term care and rehabilitation:
- Physical therapy: Strength and coordination are enhanced by doing physical therapy. Patient can learn how to use any necessary assistive equipment, such as a wheelchair, canes, or braces, from their physical therapist.
- Occupational therapy: This will assists those who have transverse myelitis in learning new techniques for conducting daily tasks including cooking, cleaning, and taking a shower.
- Psychotherapy: Talk therapy can be used by a psychotherapist to treat sexual dysfunction, anxiety, sadness, and other emotional or behavioral problems brought on by transverse myelitis.
- Prognosis: Although most transverse myelitis patients recover at least partially, it could take a year or longer. The majority of healing happens within the first three months following the incident and is highly dependent on the transverse myelitis’s underlying cause.
The course of transverse myelitis is highly variable and unpredictable. The prognosis and response to treatment depend primarily on the underlying cause of the syndrome, and to a lesser extent, how soon treatment is initiated. Generally, individuals who experience a rapid onset of severe symptoms and test positive for a specific antibody have a worse prognosis than those who develop symptoms more gradually and test negative for antibodies.
