Transverse myelitis

What is transverse myelitis?

Transverse myelitis (TM) is an inflammatory disease of the spinal cord. This condition causes neurological (nerve) symptoms such as loss of muscle strength and sensory symptoms like ‘pins and needles’. It can also cause problems with bladder and bowel function. While TM can occur in both adults and children, it is an uncommon condition.

What are the symptoms of transverse myelitis?

There are four main symptoms of TM:

1. Weakness of the legs and arms — if you have TM, you may have weakness in your legs that progresses quickly. If the upper spinal cord is also involved, your arms will be affected too. You may develop partial or complete paralysis of your legs.
2. Pain — you may initially have lower back pain or shooting sensations down your body or limbs.
3. Sensory changes — you may experience tingling, burning, numbness, pricking or coldness. You may also develop sensory loss, where you can’t feel anything at all.
4. Bowel and bladder problems — you may feel an increased frequency or urge to use the toilet, incontinence (where you can’t control your bladder or bowel movements) or constipation.

You may also experience fever, muscle spasms, headache and loss of appetite.

Symptoms of TM can develop rapidly over several hours to several weeks and are either acute (with symptoms developing within hours or days) or subacute (with symptoms developing over 1 to 4 weeks).

What causes transverse myelitis?

TM is caused by inflammation of the spinal cord. This can be caused by a wide range of medical disorders, including:

• Immune system disorders for example, multiple sclerosis and neuromyelitis optica
• Infectious conditions — bacterial, fungal, parasitic and viral infections can trigger TM
• Inflammatory disorders, for example, sarcoidosis, or Sjogren’s syndrome
• Vascular disorders, for example, arteriovenous malformation or disc embolism

Often the exact cause of TM is unknown.

When should I see my doctor?

If you are experiencing any weakness in your limbs or lower back, or get shooting pains, changes in sensation or problems with bowel or bladder function, see your doctor immediately or go to your closest emergency department.

How is transverse myelitis diagnosed?

To diagnose TM, your doctor will look at your medical history and perform a neurological examination. Your doctor may then refer you for tests:

• Blood tests can help identify the cause of the TM.
• An MRI of your brain and spinal cord can help your doctors see what part is affected and if a cause of the TM can be found.
• A CT of the spine can identify what part of the spinal cord is involved.
• A lumbar puncture may also be performed. Your doctors will take a sample of spinal fluid and send it to the lab to check for white blood cells, protein and other things that can help identify a cause of the TM.

How is transverse myelitis treated?

There is no cure for TM but there are treatments to help reduce your symptoms.

Intravenous (IV) corticosteroid medicine (a medicine given through your veins) is commonly used to treat TM. This medicine helps reduce the swelling and inflammation in your spinal cord, and calms the activity of your immune system.

Plasmapheresis, or plasma exchange therapy, can help if you don’t respond well to corticosteroid therapy. It works by removing plasma from your body. Plasma contains proteins and antibodies that are thought to be causing the inflammatory reaction.

Intravenous immunoglobulin (IVIG) is another treatment used to help reset your immune system.

If a virus is causing TM, a doctor may prescribe an antiviral medicine. Pain medicines are also used to manage pain associated with this condition.

Can transverse myelitis be prevented?

There is no definite way to prevent TM. If you have an underlying condition that can cause TM, treating and managing the underlying condition may help to prevent you developing TM.

Complications of transverse myelitis

Recovery from TM usually starts between 2 and 12 weeks after symptoms begin and may continue for up to 2 years.

About 1 in 3 people with TM will recover with either little or no neurological problems. Another 1 in 3 people with TM will have moderate disabilities, while the other third will have severe disabilities.

Common ongoing effects of TM include neuropathic pain (pain from nerves) and continual bladder or bowel problems.

Rehabilitation including physiotherapy can help improve function and strength, even if you’ve had symptoms for several years.