What are the differences between MS and transverse myelitis?

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MS is a condition that affects the CNS.

It occurs when the immune system mistakenly attacks the myelin sheath that surrounds and protects nerve fibers. Myelin enables nerves to conduct electrical signals quickly and effectively.

The immune attack causes inflammation, which erodes the myelin sheath and may damage the underlying nerves. This process can sometimes leave a scar.

The term multiple sclerosis means “scar tissue in multiple areas.” The loss of myelin may prevent the body from carrying out certain functions.

Transverse myelitis is a neurological condition that causes inflammation in a single area of the spinal cord. Over time, this inflammation damages the myelin covering the nerves in the spine.

Myelin insulates the nerves so that they can efficiently send electrical impulses from the brain around the body. These impulses control almost all bodily functions, from breathing to muscle contraction.

The brain also receives sensory information via the spinal cord from nerves throughout the body. This sensory information helps the brain detect sensations such as pain or temperature.

The areas of the body transverse myelitis affects will depend on where the inflammation is in the spinal cord. For example, with transverse myelitis in the lower spinal cord, a person may experience leg weakness. When symptoms develop in the upper spinal cord, weakness in the arms could occur.

MS is an autoimmune disease where immune cells attack nerve cells in the brain and spinal cord, including those in the brain. The inflammation and loss of myelin can sometimes leave lesions or areas of scar tissue on the brain and spinal cord.

Transverse myelitis can be an autoimmune disorder, though the exact cause is often unknown. Sometimes, transverse myelitis can progress to MS or be a symptom of it.

Because MS has similar symptoms to transverse myelitis, people can mistake the two conditions for each other.

Both may cause the following:

• pain
• tingling and numbness
• muscle weakness
• loss of bladder control

Because transverse myelitis only occurs in the spine, it usually does not affect a person’s vision. However, symptoms of MS can develop in the brain or optic nerve.

Vision problems are a common and often an early symptom of MS.

Potential causes of MS can include:

• Immune response to infection: If viruses share a similar molecular structure with the brain or nerves, they can trick the immune system into attacking the nervous system. This process is called molecular mimicry.
• Genetics: While people do not necessarily inherit MS, some genes can increase a person’s risk of developing it.
• Epstein-Barr virus (EBV): Around 95% of the population contracts EBV. It is not necessarily the virus that can increase MS risk but a person’s immune response to EBV.

Possible causes of transverse myelitis may include:

• Autoimmune disorders: These include MS and aquaporin-4 autoantibody-associated neuromyelitis optica.
• Immune system changes during cancer: This mainly occurs in cancers that affect the nervous system.
• Post-infectious or post-vaccine autoimmune phenomenon: This is when the body attacks parts of the nervous system in response to an infection or, rarely, a vaccine.

Some environmental risk factors can increase MS and transverse myelitis risk.

Smoking and not getting enough vitamin D are risk factors for developing MS. People who smoke also tend to have more aggressive MS symptoms than those who do not.

Parasites, including Toxoplasma gondii, which people can get from eating undercooked meat or drinking contaminated water, can increase the risk of transverse myelitis.

Doctors diagnose MS and transverse myelitis in several ways. The tests to diagnose both conditions are the same, and include:

• MRI imaging to detect lesions in the brain and spinal cord
• lumbar puncture with spinal fluid analysis
• evoked potential tests
• CT scans
• blood tests

However, it is important to note that a healthcare professional can only make a diagnosis of MS if a person has more than one episode.

Otherwise, a doctor may instead diagnose clinically isolated demyelination until another episode occurs. Typically, a doctor will diagnose transverse myelitis during an individual episode.

While several treatments aim to stop the progression of MS and transverse myelitis, there is currently no cure.

Treatments for MS include:

• intravenous (IV) corticosteroid drugs for treating exacerbations
• plasma exchange therapy for treating exacerbations
• a range of disease-modifying treatments, including beta interferon and glatiramer, to prevent exacerbations

A healthcare professional will treat transverse myelitis as a single event, distinguishing it from MS treatment. Treatments may include:

• IV corticosteroid drugs
• plasma exchange therapy
• antibody therapy called intravenous immunoglobulin

A healthcare professional may also recommend pain medications and muscle relaxants for treating pain or muscle spasms that may occur with MS or transverse myelitis.

Symptoms of MS and transverse myelitis can be similar, as both conditions affect the central nervous system.

Doctors use various tools to diagnose them, such as imaging studies and spinal fluid analyses. The main difference is that MS causes damage to nerves in the brain and spinal cord, while transverse myelitis only affects the spinal cord.

There is currently no cure for MS and transverse myelitis. However, several treatments aim to stop symptom progression and prevent further damage to the central nervous system.