A rare neurological disorder that causes inflammation of the spinal cord is called transverse myelitis (TM). In most cases, people who develop this condition notice that symptoms appear suddenly. These include muscle weakness, bladder dysfunction, and pain. In general, there are a lot of factors that may cause this condition. Sometimes, people recover completely from the symptoms and complications, but others do not.
The spinal cord is a cylindrical structure that goes through the center of the spine, which begins from the brainstem to the lower back. It is a structure that contains a bundle of nerves that carry signals from the brain to the rest of the body.
TM often occurs due to inflammation of the covering (myelin sheath) around the nerve cells. Therefore, it interrupts the signals that travel between the spinal nerves and the rest of the body. As a result, loss of sensation, movement, and bladder control may occur.
This neurological disorder may happen in any region along the spine. Mostly, TM is a one-time condition with a sudden onset and then followed by improvements and stabilization.
In general, this is a rare condition that affects about 1 to 8 out of every 1 million people per year.
Symptoms
Usually, the symptoms appear within a few hours or days, but may appear within several weeks. Moreover, the symptoms caused by TM often suddenly become severe. These symptoms tend to occur at or below the affected part of the spinal cord. For instance, if damage occurs in the middle back below the arms, then the legs and bladder will probably be affected, but the arms would not.
In most cases, this neurological disorder affects both parts of the body, and rarely only one part (more common in people with multiple sclerosis). The most severe symptoms that affect about 50% of people who develop TM include loss of all movements of the legs, numbness, and bladder dysfunction. While some people recover fast and completely, others may experience complications of this condition for the rest of their lives.
The symptoms of TM are divided into different groups, including abnormal sensations, pain, bowel and bladder problems, muscle and movement issues, sexual dysfunction, and other symptoms.
Abnormal Sensations
These include:
- Numbness
- Pricking
- Burning
- Increased or decreased sensitivity to touch or temperature
Pain
This symptom is often felt as sharp or blunt, and it may occur in the arms, legs, or wrap around the chest. In some cases, pain may occur in the abdominal (belly) area.
Bowel and Bladder Symptoms
Check below some symptoms that usually occur in people with TM:
- Urinary retention (inability to empty the bladder completely)
- Bladder control problems (including urge incontinence)
- Urinary incontinence (urine leakage)
- Constipation
Muscle and Movement Issues
Those who suffer from TM may experience weakness in the legs that often progresses quickly. Check below some symptoms:
- Muscle spasms
- Walking problems
- Partial or complete loss of muscle function (paralysis)
- Loss of balance
Sexual Dysfunction
People with transverse myelitis may also experience sexual dysfunction, such as anorgasmia (difficulty or lack of orgasm). Moreover, it may also cause erectile dysfunction in men.
Other Symptoms
For example:
If you experience any of the previous symptoms, contact your healthcare professional right away.
Causes
Generally, this condition is caused by an inflammation of the spinal cord. It often occurs when the immune system fights offending agents (including bacteria, toxic chemicals, viruses, and other germs). Commonly, the immune system releases inflammatory cells and cytokines (specific substances that stimulate the production of more inflammatory cells). Therefore, inflammatory cells begin to trap bacteria and other invaders or start healing the injured tissue. Usually, this inflammatory process is necessary, but sometimes the immune system may release these responders that attack healthy tissue without reason. In people with TM, damage occurs to the spinal cord.
Physicians have categorized the causes of TM into several groups. For example, idiopathic (it is not possible to determine the cause), inflammation from an infection, systemic inflammatory autoimmune diseases, and central nervous system diseases.
Idiopathic TM
In such cases, physicians cannot identify the exact cause of transverse myelitis. Moreover, the idiopathic cause accounts for more than 50% of diagnosed TM. While researchers have identified that the immune system produces responders that attack healthy tissue in the spinal cord, they cannot identify what triggers this reaction.
Infections
These include bacterial, fungal, or viral infections that cause inflammation in the body. Check below some examples:
- Herpes viruses (including genital herpes)
- HIV infection
- Enteroviruses (a common type of virus that causes mild illnesses)
- West Nile Virus
- Varicella-zoster virus (it causes chickenpox and shingles)
- Human T-cell leukemia virus type 1 (HTLV-1)
- Zika virus
- Neuroborreliosis (Lyme disease)
- Syphilis
- Tuberculosis
- Bacterial skin infections
- Mycoplasma pneumoniae
In general, it is quite challenging to determine whether a viral or post-infectious response causes TM.
Systemic Inflammatory Autoimmune Conditions
Check below some conditions that are often associated with TM:
- Behcet’s disease
- Mixed connective tissue disease
- Sarcoidosis
- Scleroderma
- Sjögren’s syndrome
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Antiphospholipid syndrome
- Ankylosing spondylitis
Central Nervous System Diseases
These include:
- Multiple sclerosis (MS)
- Acute disseminated encephalomyelitis
- Myelin oligodendrocyte glycoprotein antibody disorders (MOGAD)
- Neuromyelitis optica spectrum disorder (NMOSD) – This condition is also known as Devic’s disease
Sometimes TM is a primary symptom of a central nervous system disorder, including MS or NMOSD. While partial (only one part of the body is affected) myelitis often occurs in people with MS, a complete (affects the whole body) myelitis happens mostly in people with NMOSD. It may lead to severe paralysis and numbness of both sides of the body.
Diagnosis
Usually, the diagnosis of this TM begins with a physical examination to check for irregularities linked to the disease. They may also ask some questions about the symptoms and medical history. However, to confirm the condition and rule out other health problems (including a spinal tumor or herniated disk), physicians may perform some tests. Check below some of them:
- MRI (magnetic resonance imaging) scans – This is an imaging test used to get detailed images of the spine. It uses a large magnet and radio waves to make images.
- Brain MRI – This is the same imaging test, but it is done to check the brain’s structures. It may help get more clues about the disease or the underlying cause (such as multiple sclerosis).
- Spinal tap (also known as lumbar puncture) – This test involves a needle that is inserted into the lower back to get a sample of cerebrospinal fluid (CSF). Doctors often perform this laboratory test to check for an increased level of white blood cells or IgG index because these are common inflammatory markers in people with TM.
- Blood tests – These tests are done to check for infections and immune system-related causes.
When these tests do not suggest a specific cause, the condition is called idiopathic transverse myelitis.
Treatment
While doctors prescribe different treatments for people with TM, the goal of the treatment is to reduce inflammation, lessen the symptoms, and manage chronic complications of TM. In general, there are two forms of treatment for TM: acute (short-term) and chronic (long-term) treatment.
Short-term Treatment of TM
The primary treatment for people with TM is intravenous (IV) glucocorticoids. These medications are a type of corticosteroid used to reduce inflammation and work with the immune system. However, doctors may recommend other treatments for people who have TM. For example:
- Plasma exchange therapy (plasmapheresis) – This treatment is recommended by doctors to clean the blood. It involves the replacement of plasma, which helps remove antibodies that cause inflammation. Plasmapheresis is often prescribed for people who have TM caused by acute central nervous system demyelinating disease.
- Intravenous immune globulin (IVIG) – IVIG involves antibodies that are delivered intravenously into the body. It helps reduce inflammation in the spinal cord.
- Immunosuppressant medicines – Physicians often prescribe Rituximab and Cyclophosphamide. These medications are recommended when glucocorticoids do not work.
- Other medicines – These include medications to lessen the symptoms, such as pain, muscle spasms, urinary problems, or depression.
Long-term Treatment of TM
The following treatment options are often recommended after short-term treatments to improve functional skills and prevent TM complications. While rehabilitation cannot reverse physical damage caused by TM, it may help you cope with severe paralysis as well as improve your quality of life. Check below some long-term treatments:
- Urinary function management – Problems with urinary function are a common symptom of TM. Thus, doctors may recommend condom catheters, medicines, clean intermittent catheterization, and other procedures to improve the function.
- Management of bowel function – Most people who develop TM may also have constipation, and doctors usually recommend dietary changes, rectal stimulation, and stool softeners.
- Sexual dysfunction treatments – healthcare professionals may prescribe erectile dysfunction (ED) medications. These include Vardenafil, Sildenafil citrate, Tadalafil, and others. While these medicines are less effective for women, they can still enhance sexual functioning.
- Options to prevent pressure injuries (also known as bedsores) – These types of sores often occur in people who stay in bed for long periods. Hence, physicians often recommend changing the position (every 15 minutes) and wheelchairs with a power mechanism that recline or tilt-in-space to redistribute weight.
- Muscle tightness management – Doctors usually recommend stretching practices and the use of braces and splints to prevent muscle tightness.
- Mobility management – It often involves a physical therapist providing specific exercises to improve mobility. You can also use mobility aids, including walkers, braces, wheelchairs, canes, and others.
- Painkillers – Doctors usually recommend Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), such as Naproxen sodium or Ibuprofen, or heating and cooling therapy to relieve pain caused by TM.
- Psychological management – Some people with TM may develop a mental health condition called depression. In such cases, you may be referred to a therapist or psychologist to manage the symptoms. Sometimes, doctors may prescribe some medications to reduce the symptoms.
Frequently Asked Questions
Can vaccines cause transverse myelitis?
In rare cases, people have reported that they get vaccines a few days before TM occurs. In general, the research has proven that vaccinations are safe.
Can you recover from transverse myelitis?
While some people recover completely from symptoms and complications of TM, others recover partially and still need treatment for the rest of their lives. For more details, discuss it with your physician.
When should I see my healthcare provider for transverse myelitis?
If you experience sudden and severe symptoms such as muscle weakness and pain, it is advised to call 911 or go to the nearest emergency room (ER). Otherwise, it may lead to an increased risk of permanent complications. Ask your healthcare professional if you have any other questions.
