Transverse myelitis (TM) is a rare disorder causing inflammation of the spinal cord. It can lead to symptoms such as pain, weakness, numbness, and in some cases, paralysis.
Because it is relatively rare, TM affects just 1–8 people per million each year. It can occur in individuals of all ages and has no familial association.
This article examines TM, its symptoms, diagnosis, and treatment.
Transverse myelitis is a term used to describe general swelling across both sides of one segment of the spinal cord. It can cause symptoms affecting either one or both sides of the body.
Other conditions can cause similar symptoms, so TM is considered a diagnosis of exclusion. This means a doctor will perform tests to check for other causes before diagnosing a person with TM.
There are two primary subtypes of TM: acute complete transverse myelitis (ACTM) and acute partial transverse myelitis (APTM).
In ACTM, there are long areas of symmetrical nerve demyelination, which is damage to the protective covering surrounding nerve fibers. APTM has shorter areas of damage and different symptoms on different sides of the body.
TM may also be a sign of multiple sclerosis (MS) in some people. If an individual with TM also has an abnormal brain MRI with more than two lesions, they have up to a 90% chance of then developing MS.
Inflammation in the spinal cord interrupts nervous pathways and can cause various symptoms, including:
- progressive muscle weakness
- paralysis, often starting in the legs
- diminished touch and temperature sensations
- tingling, numbness, and burning sensations
- sexual dysfunction
- increased urinary urgency or incontinence
These symptoms may progress over hours or days. In most people, neurological function appears to decline most between days 4–21.
There is no cure for TM. Therefore, treatment aims to relieve symptoms.
Doctors usually prescribe steroids to decrease inflammation during the first few weeks following a TM diagnosis. However, these may be more effective for some people than others.
Individuals who do not respond to steroids may undergo
For some people, a doctor may also recommend other medications to control pain and secondary symptoms.
The overall aim of treatment is to allow the body to function while waiting for the nervous system to recover spontaneously. It may recover either completely or partially.
Individuals with acute symptoms, such as paralysis, often receive treatment in a hospital. They can then have treatment at a rehabilitation facility.
Physical and occupational therapy should begin immediately to help the individual improve their muscle strength, coordination, and range of motion. Additionally, a person may benefit from psychological therapy to support their mental health.
Many cases of TM are unexplained and have no clear cause. Some possible causes include:
- infections such as varicella-zoster, herpes simplex virus, Epstein-Barr, HIV, hepatitis A, and rubella
- bacterial skin infections
- middle-ear infections
- bacterial pneumonia
- fungal infections
- parasites, including Lyme disease
- immune system disorders
- disorders that damage or destroy myelin, such as MS or neuromyelitis optica (NMO)
- vascular disorders such as malformations of the arteries and veins
Some experts suggest that infection triggers problems within the immune system, leading it to attack healthy tissue in the spinal cord. This can lead to inflammation and damage to myelin.
Doctors take a medical history and perform a thorough physical and neurological examination to diagnose TM. They may use the
- Magnetic resonance imaging (MRI): These imaging studies create a three-dimensional image of the brain and spinal cord. Typically, a spinal MRI shows an injury, while a brain MRI could help identify the causes, such as MS.
- Blood tests: Doctors can use blood tests to rule out conditions such as HIV and vitamin B12 deficiency. These tests can also look for autoantibodies, which are proteins that immune cells create. Some autoantibodies link to cancer or certain autoimmune disorders, so they can help a doctor find the cause of a person’s TM.
- Lumbar puncture: Also called a spinal tap, this test involves analyzing spinal fluid to look for protein and white blood cells that help the body combat infections.
Doctors may diagnose the individual with idiopathic transverse myelitis if none of the tests indicate a specific cause.
According to NORD, after 1–3 months of treatment, a person should start to notice improvements in their symptoms. If this is not the case after 3 months, they are less likely to recover completely.
About one-third of people recover with only mild symptoms. Another one-third have a permanent disability, and the remaining individuals have a functional disability.
Transverse myelitis is an inflammatory condition that causes swelling and inflammation across one area of the spinal cord. This can lead to symptoms such as muscle weakness, paralysis, incontinence, pain, and weakness.
Doctors believe that infections and immune system disorders can trigger the condition. At present, there is no cure, but treatments can improve symptoms.