Transverse Myelitis

What is Transverse Myelitis?

Transverse myelitis (TM) is a rare condition that occurs when inflammation develops in a specific part of the spinal cord, often leading to sudden weakness, loss of sensation, and problems with bowel and bladder function. This condition usually happens on its own, often after an infection, but it could also be linked with other conditions that cause inflammation in the nervous system.

These related conditions might include acute disseminated encephalomyelitis, which is inflammation in the brain and spinal cord, multiple sclerosis, which affects the brain and spinal cord, neuromyelitis optica spectrum disorder, which affects the eyes and spinal cord, and acute flaccid myelitis, which involves sudden muscle weakness.

TM can affect any part of the spinal cord, although the chest or thoracic region is the most commonly affected. The inflammation spreads across the spinal cord, causing problems on both sides of the body. However, in some cases, the symptoms might only affect part of the body or be more severe on one side than the other.

The length of this disease varies significantly – it could last for just a few months, or it could cause permanent disability. At its worst, half of people with TM can’t move their legs at all, and nearly all of them experience some level of bowel or bladder dysfunction.

About a third of people with TM recover with little to no lasting problems, a third end up with a moderate level of permanent disability, and for another third, the condition causes severe, permanent disability.

What Causes Transverse Myelitis?

There are many reasons that can cause Transverse Myelitis (TM) – a condition where both sides of one section of the spinal cord become inflamed. These reasons can be grouped into four categories: unknown causes (idiopathic), following an infection (postinfectious), related to inflammation throughout the body (systemic inflammation), or as part of a broader disease affecting many parts of the brain and spinal cord (multifocal central nervous system disease). The most common reason for TM is unknown – no specific cause can be identified.

Among infections that can lead to TM are various viruses and bacteria, like the enteroviruses, West Nile virus, herpes viruses, HIV, human T-cell leukemia virus type 1 (HTLV-1), Zika virus, Lyme disease bacteria, Mycoplasma bacteria, and Treponema pallidum bacteria.

TM is associated with certain brain and spinal cord autoimmune disorders where the body’s immune system attacks its own cells. These include multiple sclerosis, neuromyelitis optica spectrum disorder, and acute disseminated encephalomyelitis, a brief but widespread attack of inflammation in the brain and spinal cord. Neurosarcoidosis (an inflammatory disease that affects mostly the lungs, skin, or lymph nodes) and paraneoplastic syndromes (rare disorders triggered by an altered immune system response to a cancer) have also been linked to TM.

Lastly, a number of systemic inflammatory autoimmune disorders are also associated with TM. These include conditions like ankylosing spondylitis, antiphospholipid syndrome, Behçet disease, mixed connective tissue disease, rheumatoid arthritis, sarcoidosis, scleroderma, Sjögren syndrome, and systemic lupus erythematosus – they all involve inflammation and can affect various parts of the body.

Risk Factors and Frequency for Transverse Myelitis

Transverse Myelitis (TM) is a condition that affects both men and women equally. However, in cases associated with multiple sclerosis, women tend to be more affected. TM doesn’t discriminate by age and can affect people of all ages. However, it’s more common around the ages of 10, 20, and 40-plus years. These age groups, specifically 10 to 19 and 30 to 39 years, have a higher number of TM cases. The condition is not very common, with only 1 to 8 new cases occurring per million people each year. There seems to be no differences between people born in Europe/America and those born in Africa/Asia.

TM can affect anyone, irrespective of their age.
It’s more common during the ages of 10 to 19 and 30 to 39.
Approximately, 1 to 8 new TM cases are reported per million people each year.
No significant occurrence differences between people from Europe/America and Africa/Asia.
About 64% of TM cases are idiopathic (primary TM), meaning they have no known cause.
The remaining 36% are associated with another illness (secondary TM).
Other studies have found that idiopathic TM accounts for 15 to 30% of cases.

Signs and Symptoms of Transverse Myelitis

Transverse Myelitis (TM) is a medical condition that often starts quickly or suddenly. Its main features are problems connected to nerves in the body. Symptoms might include issues with movement (motor function), feeling or sensation (sensory function), or internal body processes (autonomic function).

Motor function issues often involve quickly-developing muscle weakness, which can first affect the arms, proceeding from a state of limpness to stiffness. This occurs due to damage to certain parts in the spinal cord.
Sensory function issues commonly come with symptoms like pain, abnormal sensations, and numbness or tingling where the problem is.
Autonomic dysfunction symptoms of TM may include a frequent need to urinate, inability to control bladder or bowel, difficulty urinating, constipation, or sexual problems. The first sign of the condition could be the inability to release urine, and this should be thoroughly investigated.

The symptoms can vary depending on where along the spine the issue is. If the problem is:

At the top of the neck (C1-C5 region), it may affect all arms and legs. If the phrenic nerve is affected, it might lead to dysfunction in the diaphragm and cause problems with breathing. Almost 20% of cases have these kinds of issues.
In the mid-neck to upper back area (C5-T1 region), it may cause signs of motor function issues in the arms and both kinds of motor neuron signs in the legs.
In the mid-back area (T1-T12 region), the most common area which is affected in around 70% of cases, it may cause both types of motor neuron signs in the legs.
In the lower back and tailbone area (L1-S5 region), it may cause motor neuron signs in the legs. Around 10% of cases experience this.

The sensory symptoms often affect the region of the spine where the problem is or one level above or below it. There might also be back pain in the corresponding region of the spine where the issue is situated.

Testing for Transverse Myelitis

To diagnose transverse myelitis (TM), a condition that affects your spinal cord, often causing symptoms like pain, weakness, and muscle stiffness, a doctor has to first ensure that your symptoms aren’t being caused by a spinal cord injury. This is usually done using magnetic resonance imaging (MRI), a type of scan that creates detailed images of the body. This test can help doctors see if the spinal cord is being compressed, which can cause symptoms similar to TM.

After ruling out a spinal cord injury, the doctor will usually recommend a gadolinium-enhanced MRI or a lumbar puncture (LP), which is a procedure where a needle is inserted into the lower part of your back to draw out a sample of cerebrospinal fluid (the fluid that surrounds your brain and spinal cord). These tests help confirm if there is inflammation in your spinal cord, which is a key sign of TM.

Although there are certain diagnostic criteria for TM, not all of these need to be met in every case, and they’re mainly used for research purposes. These criteria include:

* Sensory, motor, or “automatic” functions (like breathing or digestion) being affected
* Changes in the MRI scan that suggest damage to the spinal cord
* No signs of a spinal cord injury
* Symptoms affecting both sides of your body
* A clear limit to the area where your sensory functions are affected
* Signs of inflammation in either the MRI or fluid from the lumbar puncture
* The worst symptoms occurring between 4 hours and 21 days

When trying to diagnose TM, the doctor may also ask for several other tests. These might include another MRI scan of your whole spine, an MRI of your brain, fluid analysis from the lumbar puncture and different blood tests to check for other possible causes of your symptoms.

If the MRI shows a larger area of your spinal cord is affected, your doctor might also ask for additional tests to help understand why this is happening.

Other tests might be ordered depending on your specific symptoms and medical history, like an eye exam, tests for different infections, a nose and throat swab, or tests for different vitamin levels.

Treatment Options for Transverse Myelitis

The preferred treatment for transverse myelitis (TM), a condition where segments of the spinal cord become inflamed, generally involves the use of strong anti-inflammatory drugs called glucocorticoids. These drugs are usually given through an IV as soon as possible; getting treatment started quickly is important, so doctors don’t wait for every test result before they begin treatment. These medications are generally safe and only a few conditions may prevent their use.

In some cases, if the glucocorticoid treatment doesn’t seem to be working, physicians might recommend a treatment known as plasma exchange. This is a procedure where your blood is taken out of your body, the components are separated, and then the blood cells are mixed with a special protein solution (plasma) and returned to your body.

As researchers learn more about TM, they’re exploring other treatments, such as using drugs to modulate the immune system if the TM keeps coming back or doesn’t respond to the first-line treatments. Therapies might include drugs such as cyclophosphamide, mycophenolate, or rituximab.

Furthermore, managing TM includes other aspects besides the inflammation. For example, doctors would also focus on pain management, using intravenous immunoglobulin (a blood product used to treat a variety of medical conditions), and antivirals (medications that slow the progress of virus in the body).

When looking for the underlying cause of TM, or transverse myelitis, doctors have to consider a wide range of diseases, typically those that cause damage to the spinal cord (myelopathy). Some of these conditions could be:

Damage to the spinal cord due to a slipped disk or spinal compression fractures
Backbone infection (spondylitis) or mass/abscesses in the area surrounding the spinal cord (epidural abscesses/masses)
Damage due to blood flow problems (vascular causes)
Damage due to abnormal metabolism or nutritional issues
Cancerous growths (neoplasms)
Damage due to radiation exposure
Damage due to infections or an overactive immune system (autoimmune diseases), which can lead to TM as a secondary effect

The treatment for transverse myelitis usually involves addressing these underlying causes. Guillain-Barré syndrome, a disorder in which your body’s immune system attacks your nerves, should also be thought of when assessing TM.

What to expect with Transverse Myelitis

Most people suffering from idiopathic Transverse Myelitis (TM) – a type of inflammation of the spinal cord – can expect at least some degree of recovery. This recovery usually starts within 1 to 3 months and continues with exercise and rehabilitation therapy. However, recovery might take years, and some level of continued disability may persist, this happens in about 40% of the cases.

Unfortunately, patients who initially suffer from a quick onset of complete paralysis and spinal shock generally have a worse outlook. The majority of patients will only have one episode of TM. But for those with chronic diseases, TM might reoccur. The most significant recovery typically happens within the first three months from when the symptoms start, but total recovery can take as long as two years. If there is no recovery within the first 3 to 6 months, then it’s likely that recovery may not happen.

Possible Complications When Diagnosed with Transverse Myelitis

People with Transverse Myelitis (TM) face multiple health issues. These include persistent bladder infections, ongoing bedsores, continual pain, muscle stiffness, severe depression, and sexual difficulties among other problems. There is also a 5% to 10% risk that patients showing up with TM will develop Multiple Sclerosis (MS) especially if their TM is severe. This is usually because MS first shows itself through TM.

Common Health Risks:

Persistent bladder infections
Ongoing bedsores
Chronic pain
Muscle stiffness
Severe depression
Sexual difficulties
Possibility of developing Multiple Sclerosis

Preventing Transverse Myelitis

Transverse Myelitis (TM), a condition affecting your spinal cord, cannot be prevented. However, it’s important for patients to fully understand the expected progression, diagnosis process, treatment options, and how the disease may affect their daily life. This includes an in-depth discussion about the pros and cons of using high-dose steroids, a commonly used treatment method.

To put it simply, TM affects everyone differently. Approximately, one out of three patients will fully recover, another third will experience a partial recovery, and the last third might live with permanent disabilities. Furthermore, TM usually strikes just once, and does not come back, unless it is due to a chronic ongoing health condition.

Currently, the main treatments for the acute phase of TM are steroids and drugs that lower your body’s immune response. There are also some new kinds of drugs, called monoclonal antibodies, that may change the way the disease progresses. But these are still being studied and are not in common use.

Recovering from TM involves intensive physical therapy and occupational therapy, which involves relearning skills of daily living. These therapies play a key role in ensuring the best possible outcome for individuals affected by this condition.

Frequently asked questions

Transverse Myelitis is a rare condition that occurs when inflammation develops in a specific part of the spinal cord, often leading to sudden weakness, loss of sensation, and problems with bowel and bladder function.

Approximately, 1 to 8 new TM cases are reported per million people each year.

Signs and symptoms of Transverse Myelitis include: - Motor function issues, such as quickly-developing muscle weakness that can start in the arms and progress to stiffness. This is caused by damage to certain parts of the spinal cord. - Sensory function issues, which can manifest as pain, abnormal sensations, numbness, or tingling in the affected area. - Autonomic dysfunction symptoms, including frequent urination, inability to control bladder or bowel, difficulty urinating, constipation, or sexual problems. The inability to release urine could be the first sign of the condition and should be thoroughly investigated. - The symptoms can vary depending on the location of the problem along the spine: - If the problem is in the top of the neck (C1-C5 region), it may affect all arms and legs and can lead to breathing problems if the phrenic nerve is affected. - In the mid-neck to upper back area (C5-T1 region), it may cause motor function issues in the arms and both types of motor neuron signs in the legs. - In the mid-back area (T1-T12 region), which is the most commonly affected area (around 70% of cases), it may cause both types of motor neuron signs in the legs. - In the lower back and tailbone area (L1-S5 region), it may cause motor neuron signs in the legs (around 10% of cases). - The sensory symptoms often affect the region of the spine where the problem is or one level above or below it. Back pain in the corresponding region of the spine may also be present.

Transverse Myelitis can be caused by unknown reasons, following an infection, related to inflammation throughout the body, or as part of a broader disease affecting many parts of the brain and spinal cord. Infections that can lead to TM include various viruses and bacteria. TM is also associated with certain autoimmune disorders and systemic inflammatory autoimmune disorders.

The doctor needs to rule out the following conditions when diagnosing Transverse Myelitis: - Spinal cord injury - Acute disseminated encephalomyelitis - Multiple sclerosis - Neuromyelitis optica spectrum disorder - Acute flaccid myelitis - Slipped disk or spinal compression fractures - Backbone infection (spondylitis) or mass/abscesses in the area surrounding the spinal cord (epidural abscesses/masses) - Damage due to blood flow problems (vascular causes) - Damage due to abnormal metabolism or nutritional issues - Cancerous growths (neoplasms) - Damage due to radiation exposure - Damage due to infections or an overactive immune system (autoimmune diseases), which can lead to TM as a secondary effect - Guillain-Barré syndrome

The tests needed for Transverse Myelitis (TM) include: 1. Magnetic Resonance Imaging (MRI): This scan helps doctors see if the spinal cord is being compressed and if there is damage to the spinal cord. 2. Gadolinium-enhanced MRI or Lumbar Puncture (LP): These tests help confirm if there is inflammation in the spinal cord, which is a key sign of TM. 3. Additional tests may be ordered depending on specific symptoms and medical history, such as another MRI scan of the whole spine, an MRI of the brain, fluid analysis from the lumbar puncture, and different blood tests to check for other possible causes of symptoms. 4. Other tests may be ordered to rule out other conditions or infections, such as an eye exam, tests for different infections, a nose and throat swab, or tests for different vitamin levels.

The preferred treatment for Transverse Myelitis (TM) involves the use of strong anti-inflammatory drugs called glucocorticoids, which are usually given through an IV as soon as possible. In some cases where glucocorticoid treatment doesn't work, physicians might recommend plasma exchange, a procedure where blood is taken out of the body, separated, and then mixed with a special protein solution before being returned to the body. Researchers are also exploring other treatments, such as using drugs to modulate the immune system if TM keeps coming back or doesn't respond to the first-line treatments. Additionally, managing TM includes pain management, using intravenous immunoglobulin, and antivirals.

The side effects when treating Transverse Myelitis may include persistent bladder infections, ongoing bedsores, chronic pain, muscle stiffness, severe depression, sexual difficulties, and a possibility of developing Multiple Sclerosis.

The prognosis for Transverse Myelitis (TM) varies depending on the individual case, but here are some key points: - Most people with idiopathic TM can expect at least some degree of recovery, which usually starts within 1 to 3 months and continues with exercise and rehabilitation therapy. - Recovery might take years, and some level of continued disability may persist in about 40% of cases. - Patients who initially suffer from a quick onset of complete paralysis and spinal shock generally have a worse outlook, and the majority of patients will only have one episode of TM. However, for those with chronic diseases, TM might reoccur.

A neurologist or a specialist in spinal cord disorders should be consulted for Transverse Myelitis.