Transverse myelitis is an inflammation of your spinal cord. It results from damage to nerve cells in a certain area.
A fatty tissue called myelin protects these nerve fibers. It fits around them like the insulation that covers an electrical wire.
When myelin is damaged, the nerves underneath can be hurt, too. Once your nerves are scarred, it’s harder for them to send signals to other parts of your body the way they should. This often brings pain, weakness, or paralysis.
When this happens to the nerves on both sides of part of your spinal cord, it's known as transverse myelitis.
What Causes It?
More than half the time, doctors aren't sure what causes it. But they know it can happen when your body tries to fight off a disease. Or when your immune system attacks healthy cells for some reason. It’s often linked to:
Autoimmune conditions like lupus and Sjogren's syndrome that cause inflammation.
Infections:
- Bacterial infections like Lyme disease, tuberculosis, and syphilis
- Fungal infections of the spinal cord, like aspergillus, blastomyces, coccidioides, and cryptococcus
- Parasites such as toxoplasmosis, cysticercosis, schistosomiasis, and strongyloid
- Viral Infections like varicella zoster, which causes chickenpox and shingles; enterovirus; and West Nile virus
Multiple sclerosis (MS): Transverse myelitis can be the first sign of MS, which destroys myelin in your brain and spinal cord. It can also signal a relapse.
Symptoms
Symptoms may show up in a few hours or days (your doctor will call this an acute attack). Or you might notice them gradually over a few weeks (this is called subacute). While the condition isn’t chronic, it can come back if you have a history of autoimmune disease.
The first symptoms are usually:
- Pain in your back
- Sharp pain that moves down your legs and arms or around your chest and belly
- Weakness or paralysis in your legs or arms
- Sensitivity to touch, to the point where slight fingertip pressure causes pain
- Numbness or a pins-and-needles feeling in your toes, feet, or legs
- Muscle spasms
- Fever
- Loss of appetite
- Bladder and bowel control issues
Once they start, symptoms can get worse within hours. Most of the time, they peak within 10 days. At that point, about half the people who get transverse myelitis lose control of their legs. Most have some numbness, tingling, or a burning sensation in their back, belly, arms, or legs. Almost all lose some bladder control.
How much of your body is affected depends on which part of your spinal cord has the problem. The higher it is, the more problems you’ll have.
Diagnosis
Your doctor will run tests to figure out if you have transverse myelitis or some other condition.
Magnetic resonance imaging (MRI) or computerized tomography (CT) scan: These tests create detailed images of your insides. They’ll show the doctor if something else is affecting your nerves, like a tumor, a slipped disk, or narrowing of the channel that holds your spinal cord. MRI can show demyelination, a sign of MS.
Spinal tap: For this test, your doctor puts a needle in between two vertebrae (bones in your back) to take a sample of the fluid that surrounds your brain and spinal cord. If it has more disease-fighting white blood cells or certain proteins than it should, you might have an infection. That may be a sign of TM.
Bloodwork: Your doctor will test your blood for signs of illnesses with similar symptoms, like lupus, HIV, or another form of myelitis.
What Medications Treat Transverse Myelitis?
There's no cure, so your doctor will try to manage the disease and ease your symptoms. They may suggest:
Steroids: They’ll ease inflammation in your spine. You might get pills or have it put directly into your veins.
Intravenous immunoglobulin (IVIG): The doctor will inject antibodies from healthy donors into your system. They’ll bind to your problem-causing antibodies and take them out of circulation.
Plasma exchange therapy: If steroids don’t lower your inflammation, this treatment, also called plasmapheresis, might. The doctor will replace your blood plasma (the liquid part that holds the blood cells). This might get rid of something in it that's causing your immune system to attack your body and keep it from damaging other organs.
Antiviral medications: You’ll take them if your doctor thinks a virus is causing your illness.
Medication for symptoms and complications: You might get drugs to relieve muscle spasms, help control your bladder or bowels, ease stiffness, manage depression, and help with sexual problems.
Over-the-counter pain medicines: Acetaminophen, ibuprofen, and naproxen can all help.
Prescription pain medications: Drugs that treat depression can help ease nerve pain, too. You might get drugs for depression or drugs that stop seizures.
Ventilator with a breathing tube: If your symptoms affect your breathing, this machine can help you breathe. It’ll make sure your body gets enough oxygen.
Nonmedical Treatments for Transverse Myelitis
Your doctor might also suggest:
Rest: You might need to stay in bed while you fight the illness.
Physical therapy: You’ll learn:
- Ways to keep your muscles strong and your limbs flexible while you recover
- Techniques to control your bowels and bladder
- How to use tools that make life easier, like wheelchairs, canes, or braces
Occupational therapy: This will teach you new ways to do daily chores, like cooking dinner, taking a bath, getting dressed, or cleaning the house.
Psychotherapy: This will help you manage the mental effects of anxiety, depression, sexual dysfunction, and other emotional or behavioral issues.
Vocational therapy: It can help you find a job that suits your abilities or work with your employer to make changes you need.
Are There Complications?
Sometimes. The most common are:
Pain: It’s both a symptom and a lasting complication.
Spasticity: This includes stiff, tight, and spasming muscles. It’s most common in your legs and bottom.
Sexual problems: Men may have trouble getting an erection. Both genders could have trouble reaching orgasm.
Depression or anxiety: Between the changes this disease makes to your body, the stress of living with it, the pain, and the sexual troubles, there’s a lot to handle.
What’s the Outlook?
About 1,400 people a year get transverse myelitis, and about 33,000 people have some sort of disability as a result.
About a third of people with transverse myelitis get better and don't have much permanent damage. They can walk normally and have only small lingering issues.
Another third have problems walking. They also may have muscle spasms, a less sensitive sense of touch, or trouble controlling their bladder.
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The remaining third are no longer able to walk and need help with many everyday activities.
Doctors don’t know why transverse myelitis affects some people more than others. They do think that the faster your symptoms show up, the harder it may be for you to recover. Early treatment and physical therapy can help.