Transverse Myelitis

Transverse myelitis (TM) is a serious condition that affects the spinal cord. Imagine your spinal cord as the body’s main highway for messages traveling between the brain and the rest of you. In TM, this highway gets inflamed, causing damage.

The Insulation Breakdown:

The spinal cord is protected by a fatty layer called myelin, like insulation around an electrical wire. This myelin helps nerve signals zip through quickly and smoothly. When TM strikes, it damages this myelin, disrupting the smooth flow of messages.

Nerve Signal Disruption:

Underneath the myelin are nerves that carry messages. This damage to the myelin and nerves can lead to a variety of symptoms, including:

• Pain: You might experience sharp, burning, or aching pain in your back, legs, or arms.
• Weakness: Muscles controlled by the affected nerves may become weak, making it difficult to move around.
• Paralysis: In severe cases, complete loss of movement (paralysis) can occur in the areas served by the damaged nerves

Targeting Both Sides:

What makes transverse myelitis distinct is that the inflammation affects nerves on both sides of a specific section of the spinal cord. This can cause symptoms on both sides of the body, at the same level as the inflamed area.

The Long Road to Recovery:

Recovery from TM can be a long journey, taking months or even years. Some people experience only mild issues that gradually improve, while others face permanent challenges that affect their daily lives.

Who gets TM?

While TM is uncommon, affecting about 1,400 people in the US annually, it can strike at any age. It’s more frequent, however, in two age groups: 10-year-olds and 30-39-year-olds. Additionally, people assigned females at birth are more likely to develop TM.

Transverse myelitis (TM) and Multiple sclerosis (MS)

Multiple sclerosis (MS) and transverse myelitis (TM) are both conditions that affect the central nervous system, but they have distinct differences in their causes and manifestations.

MS primarily targets the brain, spinal cord, and optic nerves, resulting from an autoimmune response where the immune system mistakenly attacks the myelin sheath surrounding nerve fibers. This autoimmune attack leads to inflammation, scarring, and disruption of nerve signals. In some cases, MS can also cause transverse myelitis, typically presenting with symptoms on one side of the body. These symptoms may be the initial signs of MS or indicate a relapse in individuals already diagnosed with MS.

Idiopathic Transverse Myelitis

On the other hand, transverse myelitis can occur independently of MS and is often idiopathic, meaning the cause is unknown. In idiopathic transverse myelitis, there may be an abnormal immune response against the spinal cord, triggering inflammation and nerve damage. Researchers have not yet pinpointed the exact triggers for this immune response.

Causes of Transverse Myelitis

The causes of transverse myelitis are not fully understood, but it is believed to result from an immune system malfunction or response to an infection. It commonly arises following the recovery from an illness, with the immune system releasing inflammatory cells that inadvertently target the spinal cord’s nerve cells, leading to damage.

In summary, while both MS and TM involve inflammation and damage to the central nervous system, MS is primarily an autoimmune condition affecting multiple areas, including the brain and spinal cord, while TM may occur as a distinct entity with unknown triggers or secondary to other conditions, including MS.

Conditions linked to Transverse Myelitis

Transverse myelitis (TM) can be linked to various underlying conditions, including autoimmune conditions, infections, multiple sclerosis (MS), neuromyelitis optica (Devic’s disease), vaccinations, and sarcoidosis. These conditions can trigger inflammation and damage to the spinal cord, leading to the characteristic symptoms of TM. Here’s how each of these conditions is associated with TM:

1. Autoimmune conditions: Diseases such as lupus, ankylosing spondylitis, antiphospholipid syndrome, Behçet’s disease, rheumatoid arthritis, and Sjogren’s syndrome are associated with abnormal immune system activity, which can lead to inflammation and damage to the spinal cord, resulting in TM.
2. Infections: Bacterial, fungal, parasitic, and viral infections can trigger an immune response that affects the spinal cord, causing TM. Examples include Lyme disease, tuberculosis, syphilis, aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, toxoplasmosis, cysticercosis, schistosomiasis, strongyloidiasis, varicella-zoster virus, enterovirus, Zika virus, and West Nile virus.
3. Multiple sclerosis (MS): Although rare, TM can be a manifestation of MS. In some cases, TM symptoms may precede other symptoms of MS or indicate a relapse of the condition.
4. Neuromyelitis optica (Devic’s disease): This autoimmune condition primarily affects the optic nerves and spinal cord, leading to inflammation and damage. TM associated with neuromyelitis optica typically affects both sides of the body and may involve symptoms related to vision.
5. Vaccinations: While rare, TM has been reported following certain vaccinations. However, the occurrence of TM following vaccination is extremely uncommon, and the benefits of vaccination generally outweigh the potential risks.
6. Sarcoidosis: Sarcoidosis is a systemic inflammatory condition that can affect various organs, including the spinal cord. Spinal cord involvement in sarcoidosis, leading to TM, is rare but can occur.

Overall, TM can result from a range of underlying conditions that lead to inflammation and damage to the spinal cord. Identifying and addressing the underlying cause is crucial for appropriate management and treatment of TM.

Symptoms of transverse myelitis (TM)

Transverse myelitis (TM) can present with various symptoms that may develop suddenly (an acute attack) over a few hours or days, or gradually (subacute) over several weeks. While TM itself isn’t chronic, it can recur in individuals with a history of autoimmune disease. The initial symptoms of TM typically include:

1. Pain in the back: Patients may experience pain in the back, which can be sharp or dull.
2. Radiating pain: Sharp pain may radiate down the legs and arms or manifest around the chest and abdomen.
3. Weakness or paralysis: Individuals may experience weakness or paralysis in the legs or arms, affecting mobility and coordination.
4. Sensitivity to touch: There may be heightened sensitivity to touch, with even slight fingertip pressure causing pain.
5. Numbness or tingling: Patients may experience numbness or a pins-and-needles sensation in the toes, feet, or legs.
6. Muscle spasms: Spasms or involuntary muscle contractions may occur, leading to discomfort or pain.
7. Fever: Some individuals may develop a fever as a result of the inflammatory response associated with TM.
8. Loss of appetite: TM can sometimes cause a loss of appetite or decreased interest in eating.
9. Bladder and bowel control issues: Patients may experience urinary urgency, constipation, or urinary or fecal incontinence due to disruptions in nerve signals.
10. Sexual dysfunction: TM can affect sexual function, leading to difficulties with arousal, orgasm, or ejaculation.
11. Headache: Headaches may occur as a secondary symptom of TM, often associated with the inflammatory process.
12. Depression and anxiety: Psychological symptoms such as depression and anxiety may arise due to the impact of TM on daily functioning and quality of life.
13. Breathing problems: In severe cases, TM may affect respiratory muscles, leading to breathing difficulties.

The extent of symptom manifestation depends on the location of the spinal cord lesion. Higher lesions typically result in more severe symptoms and functional impairments. Early recognition and prompt medical intervention are essential for managing TM and minimizing long-term complications.

Diagnosis of transverse myelitis (TM)

To diagnose transverse myelitis (TM) and rule out other potential conditions, your doctor will conduct a series of tests, which may include:

1. MRI or CT scans: These imaging tests provide detailed images of the internal structures, allowing the doctor to visualize the spinal cord and surrounding tissues. They can help identify any abnormalities, such as inflammation, tumors, herniated discs, or spinal canal narrowing. In the case of TM, MRI scans may reveal characteristic findings such as demyelination, indicating damage to the myelin sheath.
2. Spinal tap (lumbar puncture): During a spinal tap, a needle is inserted between the vertebrae in the lower back to collect a sample of cerebrospinal fluid (CSF) surrounding the brain and spinal cord. Analysis of the CSF can detect abnormalities such as increased white blood cells or elevated protein levels, which may suggest inflammation or infection associated with TM.
3. Blood work: Various blood tests may be performed to assess for underlying conditions that could mimic TM symptoms or contribute to its development. These tests may include screening for autoimmune diseases like lupus, infectious diseases such as HIV, or other forms of myelitis.

Healthcare providers can make an accurate diagnosis of TM and develop an appropriate treatment plan by analyzing the results of these diagnostic tests in conjunction with the patient’s clinical presentation and medical history. Early diagnosis and intervention are crucial for managing TM effectively and minimizing complications.

Treatment of transverse myelitis (TM)

The treatment for transverse myelitis (TM) aims to manage the disease, alleviate symptoms, and improve the patient’s quality of life. Here are some common treatment options:

1. Steroids: Corticosteroids are often prescribed to reduce inflammation in the spinal cord. They can be administered orally in pill form or intravenously through injections.
2. Intravenous immunoglobulin (IVIG): This therapy involves infusing antibodies from healthy donors into the patient’s bloodstream. These antibodies can help modulate the immune response and reduce inflammation.
3. Plasma exchange therapy: Also known as plasmapheresis, this procedure involves removing the patient’s blood plasma, which contains harmful antibodies or proteins, and replacing it with a substitute solution. Plasma exchange can help remove substances that may be contributing to the immune system’s attack on the spinal cord.
4. Antiviral medications: If a viral infection is suspected as the trigger for TM, antiviral drugs may be prescribed to treat the underlying infection.
5. Management of urinary function: Various strategies may be employed to address urinary dysfunction, including timed voiding, medications, catheterization techniques, or the use of specialized devices.
6. Treatment for sexual dysfunction: Depending on the specific symptoms experienced, treatments such as lubricants or medications like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may be recommended to address sexual dysfunction.
7. Pain management: Over-the-counter pain relievers like acetaminophen, ibuprofen, or naproxen may help alleviate discomfort. In some cases, prescription pain medications or antidepressants may be necessary to manage neuropathic pain.
8. Respiratory support: If TM affects respiratory function, a ventilator with a breathing tube may be required to assist with breathing and ensure adequate oxygenation.

Nonmedical treatments may also be beneficial, including:

1. Rest: Adequate rest is essential during recovery from TM to allow the body to heal and conserve energy.
2. Physical therapy: Physical therapists can design exercises to strengthen muscles, improve flexibility, and restore mobility. They may also teach techniques to manage bladder and bowel function.
3. Occupational therapy: Occupational therapists can provide strategies and adaptations to help individuals perform daily activities more independently, such as self-care tasks or household chores.
4. Psychotherapy: Counseling or psychotherapy can help individuals cope with the emotional and psychological challenges associated with TM, such as anxiety, depression, or adjustment to disability.
5. Vocational therapy: Vocational rehabilitation specialists can assist individuals in identifying employment opportunities, acquiring job skills, or making workplace accommodations to facilitate their return to work.

By combining medical interventions with supportive therapies, healthcare providers aim to optimize outcomes and enhance the overall well-being of individuals affected by transverse myelitis.

Complications of Transverse Myelitis

Transverse myelitis (TM) can lead to various complications and long-term effects, including:

1. Pain: Both acute and chronic pain can result from transverse myelitis, affecting the affected individual’s quality of life.
2. Spasticity: Muscle stiffness, tightness, and spasms are common in the legs and buttocks of individuals with TM, making moving challenging.
3. Sexual problems: Those assigned male at birth may experience erectile dysfunction, while both genders may face difficulties reaching orgasm due to nerve damage.
4. Depression or anxiety: Coping with the physical changes, pain, and potential sexual dysfunction associated with TM can lead to psychological distress. Seeking support from healthcare professionals is essential to managing these mental health concerns.

Outlook/Prognosis

The outlook for individuals with TM varies depending on the severity of the condition and the extent of nerve damage. While some people may fully recover with minimal residual effects, others may experience long-term disabilities. The following outcomes are observed in individuals with TM:

• Approximately one-third of individuals may experience significant recovery with minimal permanent damage, allowing them to walk normally with minor lingering issues.
• Another third may face challenges with walking, along with muscle spasms, decreased sensitivity, or bladder dysfunction.
• The remaining third may lose the ability to walk entirely and require assistance with daily activities.

Early diagnosis and treatment, along with physical therapy, can improve the prognosis for individuals with TM. However, the speed of symptom onset may influence recovery, with a faster onset associated with a more challenging recovery.

While transverse myelitis is rare and typically occurs as a single episode, it can have lasting effects on physical and mental health. However, with appropriate treatment and support, individuals can manage their symptoms and lead fulfilling lives.

FAQs

1. Can you fully recover from transverse myelitis? Yes, some individuals can fully recover from transverse myelitis and have no lingering symptoms.
2. Is transverse myelitis life-threatening? Transverse myelitis itself is not typically life-threatening, but its complications and associated disabilities can impact one’s quality of life.
3. What are the first symptoms of transverse myelitis? The initial symptoms of transverse myelitis often include weakness in the arms and legs, back pain, abnormal sensations in the legs and genital area, and bowel and bladder problems.
4. Is transverse myelitis contagious? Transverse myelitis is not contagious; it is believed to result from an abnormal immune response or infections affecting the spinal cord.

Sources

1. Cleveland Clinic: “Transverse Myelitis (TM).”
2. Clinical Orthopaedics and Related Research: “Fungal Infections of the Spine.”
3. Cureus: “Longitudinally Extensive Transverse Myelitis as a First Manifestation of Sarcoidosis.”
4. Johns Hopkins Medicine: “Transverse Myelitis.”
5. Journal of Neurosurgery: “Transverse myelitis after Johnson & Johnson COVID-19 vaccine: illustrative case.”
6. Mayo Clinic: “Transverse myelitis: Diagnosis & treatment,” “Transverse myelitis: Symptoms & causes,” “Transverse myelitis,” “Neuromyelitis optica.”
7. National Institute of Neurological Disorders and Stroke: “Transverse Myelitis Fact Sheet,” “Transverse Myelitis.”
8. National Multiple Sclerosis Society: “Transverse Myelitis (TM) and Multiple Sclerosis.”
9. National Organization for Rare Diseases: “Transverse Myelitis.”
10. National Organization for Rare Disorders: “Transverse Myelitis.”
11. Oregon Health & Science Institute: “Transverse Myelitis.”
12. Siegel Rare Neuroimmune Association: “Transverse Myelitis.”
13. Transverse Myelitis Society: “10 facts everyone should know about Transverse Myelitis.”