Tranverse myelitis

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.