TRANSVERSE MYELITIS

A disease of the spinal cord in which there is demyelination (erosion of the myelin sheath that normally protects
nerve fibers). The onset of the disorder is typically sudden. Symptoms include back pain followed by ascending
weakness in the legs. There is no cure. Many patients are left with permanent disabilities or paralysis.
Transverse myelitis occurs alone and in combination with demyelination of other parts of the nervous system. It
may be associated with multiple sclerosis.
Transverse myelitis can cause low back pain, spinal cord dysfunction, muscle spasms, a general feeling of
discomfort, headache, loss of appetite, and numbness or tingling in the legs. Almost all patients develop leg
weakness. The arms are involved in a minority of cases. (This depends upon the level of spinal cord
involvement.) Sensation, pain and temperature sensation are typically diminished below the level of spinal cord
involvement. Appreciation of vibration and joint position sense may also be decreased. Bladder and bowel
sphincter control is disturbed in the majority of cases. Many patients with transverse myelitis report a tight
banding or girdle-like sensation around the trunk and that area may be very sensitive to touch.
Transverse myelitis may be caused by viral infections, spinal cord injuries, immune disorders (including
systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis and multiple sclerosis) or insufficient blood
flow through the blood vessels in the spinal cord. It may occur as a complication of such disorders as optic
neuromyelitis, multiple sclerosis, smallpox, andmeasles, or as a complication
of chickenpox or rabies vaccinations.
The infectious agents associated with transverse myelitis include viruses and bacteria: herpes simplex, herpes
zoster, cytomegalovirus, Epstein-Barr virus,enteroviruses (poliomyelitis, Coxsackie virus, echovirus), human Tcellleukemia virus, human immunodeficiency virus (HIV), influenza, measles, and rabies, Mycoplasma
pneumoniae, Lyme borreliosis, syphilis, and tuberculosis.
There is no specific treatment for transverse myelitis. The prognosis for complete recovery from transverse
myelitis is generally not good. Although recovery usually begins between 2 and 12 weeks after onset and may
continue for up to 2 years, most individuals are left with considerable disability. Some individuals may have
minor or no deficits, while others may have significant motor, sensory, and sphincter (bowel) deficits or no
recovery at all.
Is transverse myelitis genetic/inherited?
No genetic pattern is known. Transverse myelitis is not related to family history.Back to top
Is transverse myelitis contagious?
There is no evidence to suggest that transverse myelitis is contagious.Back to top
How is transverse myelitis different from MS?
One of the many causes of transverse myelitis is MS but not all people diagnosed with MS experience
transverse myelitis.Back to top
What are the treatments for transverse myelitis?

There is no cure for transverse myelitis at this time and no medications have been specifically approved to
treat it. The standard of care for transverse myelitis includes the following:
Intravenous (into the vein) corticosteroids such as methylprednisolone or dexamethasone may be given to help
decrease the swelling in the spinal cord. In some cases, prednisone, taken by mouth, is used for a period of
time after the IV therapy is completed.
Plasma exchange (PLEX) may be ordered if no improvement occurs with corticosteroid therapy.
Cyclophosphamide, a chemotherapy drug that is often used to treat lymphomas or leukemia, is sometimes
used for those who continue to experience active inflammation of the spinal cord, despite treatment with
steroids and/or PLEX.. Patients receiving this treatment are carefully monitored for potential complications that
may arise from immunosuppression.
Many different types of medications may be used to help deal with abnormal sensations or pain. These
medications could include antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs, or narcotics.
Lidocaine patches, topical capsaicin, and botulinum neurotoxin are other options.
Non-pharmacologic approaches to addressing abnormal sensations or pain may include biofeedback, physical
therapy, acupuncture, and transcutaneous electrical nerve stimulation.

Transverse myelitis
Transverse myelitis is inflammation of the spinal cord, which often targets insulating material
covering nerve cell fibers (myelin). Transverse myelitis may result in injury across the spinal cord,
causing diminished or absent sensation below the injury.
The disrupted transmission of nerve signals due to transverse myelitis can cause pain or other
sensory problems, weakness or paralysis of muscles, or bladder and bowel dysfunction.
Several factors can cause transverse myelitis, including infections not directly affecting the spine and
immune system disorders attacking the body's own tissues. It may also occur as an episode of other
myelin disorders, such as multiple sclerosis.
Treatment for transverse myelitis includes anti-inflammatory drugs, medications to manage symptoms
and rehabilitative therapy. Most people with transverse myelitis experience at least partial recovery.

Symptoms

Signs and symptoms of transverse myelitis usually develop rapidly over a few hours and worsen over
the course of a few days. Less commonly, signs and symptoms progress gradually over several days
to weeks. Commonly, but not always, both sides of the body are affected.
Typical signs and symptoms include:
Pain. Pain associated with transverse myelitis often begins suddenly in your neck or back,
depending on the part of your spinal cord that's affected. Sharp, shooting sensations may also radiate
down your legs or arms or around your abdomen.

Abnormal sensations. Some people with transverse myelitis report sensations of numbness,
tingling, coldness or burning. Some are especially sensitive to the light touch of clothing or to extreme
heat or cold. You may feel as if the skin of your chest, abdomen or legs is being wrapped tightly by
something.

Weakness in your arms or legs. Some people with mild weakness notice that they're
stumbling or dragging one foot or that their legs feel heavy as they move. Others may develop severe
paralysis.

Bladder and bowel problems. These problems may include an increased urinary urge,
urinary incontinence, difficulty urinating and constipation.

Causes
Viral infections of the respiratory tract or the gastrointestinal tract have been implicated in transverse
myelitis. In most cases, the inflammatory disorder appears after a person has recovered from the viral
infection.
Inflammation is a normal response of the immune system to disease or injury. But sometimes the
immune system attacks the body's own tissues an event known as an autoimmune phenomenon.
The exact reason for this immune system dysfunction in transverse myelitis is not known. However,

there are a number of conditions that appear to trigger or contribute to the disorder. These conditions
include:
Mycoplasma pneumonia, a relatively mild form of pneumonia caused by a bacterium, may act
as a trigger for the immune system mechanisms causing transverse myelitis.

Multiple sclerosis is an autoimmune disorder in which the immune system destroys myelin
surrounding nerves in your spinal cord and brain. Transverse myelitis may be the first sign of multiple
sclerosis or represent a relapse of symptoms. Transverse myelitis occurring as a sign of multiple
sclerosis usually manifests on one side of your body only.

Neuromyelitis optica (Devic's disease) is a condition that causes inflammation and loss of
myelin around the spinal cord and the optic nerve, the nerve in your eye that transmits information to
your brain. Signs and symptoms of transverse myelitis associated with neuromyelitis optica usually
affect both sides of your body. Damage to myelin of the optic nerve and subsequent symptoms,
including pain in the eye with movement and temporary vision loss, may occur at the same or other
times as transverse myelitis symptoms. However, some people with neuromyelitis optica may not
experience eye-related problems and may only have recurrent episodes of transverse myelitis.

Autoimmune disorders affecting other body systems are likely contributing factors in some
people with transverse myelitis. These disorders include lupus, which can affect multiple body
systems, and Sjogren's syndrome, which causes severe dryness of the mouth and eyes, as well as
other symptoms. Transverse myelitis associated with an autoimmune disorder may indicate coexisting
neuromyelitis optica, which occurs more frequently in people with other autoimmune diseases than it
does in other people who don't have autoimmune disease.

Vaccinations for infectious diseases including hepatitis B, measles-mumps-rubella, and

diphtheria-tetanus vaccines have rarely been identified as a likely trigger.

Complications
People with transverse myelitis usually experience only one acute episode. However, complications
often linger, including the following:
Pain is one of the most common debilitating long-term complications of the disorder.

Stiffness, tightness or painful spasms in your muscles (muscle spasticity), especially in

your buttocks and legs, affect most people with lingering effects of transverse myelitis.

Partial or total paralysis of your arms, legs or both may persist after the initial onset of
symptoms.

Sexual dysfunction is a common complication arising from transverse myelitis. Men may
experience difficulty achieving an erection or reaching an orgasm. Women may have difficulty
reaching an orgasm.

Osteoporosis. Limited physical activity over the long term due to transverse myelitis may lead
to osteoporosis, a thinning or weakening of bones. People with osteoporosis are at increased risk of
bone fractures.

Depression or anxiety is common in those with long-term complications because of the

significant changes in lifestyle, the stress of chronic pain or disability, and the impact of sexual
dysfunction on relationships.

Tests and diagnosis

Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create cross-sectional
or 3-D images of soft tissues. An MRI can show inflammation of the spinal cord, and it can identify
other potential causes of the symptoms, including abnormalities causing spinal cord compression and
blood vessel malformations.
A diagnosis of transverse myelitis is based on your answers to questions about your signs and
symptoms, your medical history, a clinical assessment of nerve function, and the results of tests.
These tests, which may indicate inflammation of the spinal cord and rule out other disorders, include
the following:
Lumbar puncture, or spinal tap, is the use of a needle to draw from the spinal column a small
amount of cerebrospinal fluid (CSF), the protective fluid that surrounds your spinal cord and brain. In
some people with transverse myelitis, CSF may have abnormally high numbers of white blood cells or
immune system proteins that indicate inflammation. Spinal fluid can also be tested for viral infections
or certain cancers.

Blood tests may include a test that checks for antibodies associated with neuromyelitis optica,
a condition in which inflammation occurs both in your spinal cord and in the nerve in your eye. People
with a positive antibody test are at an increased risk of experiencing multiple attacks of transverse
myelitis and require treatment to prevent future attacks. Other blood tests can identify infections that
may be a contributing factor in transverse myelitis or rule out other causes of symptoms.

Treatments and drugs

Intravenous steroids. After your diagnosis, you'll likely receive steroids through a vein in your arm
over the course of several days. Steroids help reduce the inflammation in your spinal column.
Several therapies target the acute signs and symptoms of transverse myelitis:

Plasma exchange therapy. People who don't respond to intravenous steroids may undergo
plasma exchange therapy. This therapy involves removing the straw-colored fluid in which blood cells
are suspended (plasma) and replacing the plasma with special fluids. It's not certain how this therapy
helps people with transverse myelitis, but it may be that plasma exchange removes antibodies that
are involved in inflammation.

Pain medication. Chronic pain is a common complication of transverse myelitis. Medications

that may lessen pain associated with spinal cord damage include common pain relievers, including
acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn,
others); antidepressant drugs, such as sertraline (Zoloft); and anticonvulsant drugs, such as
gabapentin (Neurontin) or pregabalin (Lyrica).

Medications to treat other complications. Your doctor may prescribe other medications as
needed to treat problems such as muscle spasticity, urinary or bowel dysfunction, depression or other
complications associated with transverse myelitis.

Nondrug therapyOther therapies focus on long-term recovery and care:

Physical therapy. Physical therapy helps you increase strength and improve coordination.
Your physical therapist will likely teach you how to use assistive devices, such as a wheelchair, canes
or braces, if needed.

Occupational therapy. This type of therapy helps people with transverse myelitis learn new
ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.

Psychotherapy. A psychotherapist can use talk therapy to treat anxiety, depression, sexual
dysfunction, and other emotional or behavioral issues that may be related to your coping with
transverse myelitis.
PrognosisAlthough most people with transverse myelitis have at least partial recovery, the process

may take a year or more. Recovery strongly depends on the cause of transverse myelitis. People with
neuromyelitis optica have a worse prognosis, although even in this situation, most experience
recovery with treatment. About one-third of people with transverse myelitis fall into each of three
categories after an episode of transverse myelitis:
No or slight disability. These people experience only minimal residual symptoms.
Moderate disability. These people are mobile, but may have difficulty walking, numbness or
tingling, and bladder and bowel problems.

Severe disability. Some people may have permanent need for a wheelchair and require
ongoing assistance with care and everyday activities.
It's difficult to predict the course of transverse myelitis. Generally, people who experience a rapid
onset of signs and symptoms have a worse prognosis than do those with relatively slower onset.