Transverse Myelitis

Transverse myelitis is a neurological condition. It happens when the spinal cord becomes inflamed. This inflammation can damage myelin, the fatty substance that covers your nerves. Loss of myelin often leads to spinal cord scarring that blocks nerve impulses and results in physical problems.

Transverse myelitis is a relatively rare disease. It occurs most often in children ages 10 to 19 and in adults ages 30 to 39. But it can happen at any age.

In some cases, the exact cause of transverse myelitis is unknown. In other cases, the inflammation that leads to transverse myelitis can result as a side effect of a number of other health problems, such as:

• Lyme disease.

• Syphilis.

• Measles.

• Viral infections.

• Bacterial infections.

• Fungal infections.

• Parasites.

• Immune system disorders.

• Vascular disorders.

Some people may also get transverse myelitis as a result of spinal injuries, spinal defects, or vascular diseases like atherosclerosis. All of these can reduce the amount of oxygen in spinal cord tissue.

If parts of the spinal cord don’t have enough oxygen, nerve cells often start to die. The dying tissue can cause the inflammation that leads to transverse myelitis.

Transverse myelitis can also be a warning sign of multiple sclerosis. But this is rare. Since some people with transverse myelitis have autoimmune diseases such as lupus, some healthcare providers believe that transverse myelitis may also be an autoimmune disease. Finally, some cancers can trigger an immune response that leads to transverse myelitis.

The symptoms of transverse myelitis can develop over several hours or days, or over a longer period of 1 to 2 weeks. These are possible symptoms:

• Back or neck pain.

• Weakness in arms or legs.

• Abnormal feelings in the legs, such as burning, tingling, or pricking.

• Loss of bladder or bowel control.

• Heightened sensitivity to touch.

Where in the body these symptoms occur depends on what part of the spinal cord is inflamed. People with inflammation in the neck typically feel symptoms from the neck down. Inflammation in the middle of the spine can cause symptoms from the waist down.

If you suspect that you have transverse myelitis, your healthcare provider will likely review your medical history and do a complete physical exam. Because transverse myelitis can be caused by a number of treatable conditions, your provider may want to test for some of those diseases. One test you might need is an MRI.

Blood tests and a lumbar puncture (spinal tap) may also be done to rule out other causes of transverse myelitis.

If all potential underlying causes of transverse myelitis have been ruled out, it is called idiopathic.

No effective cure currently exists for transverse myelitis. But many people recover from it. Treatments focus on relieving the inflammation that causes the symptoms. Some people might need to be hospitalized at first if the symptoms are severe enough. High doses of steroids are used to suppress the activity of the immune system and help speed recovery. Your healthcare provider may also recommend pain-relieving drugs like ibuprofen or acetaminophen and plenty of bed rest. Other immune-suppressing drugs may be prescribed as well.

If steroids don’t relieve the symptoms of transverse myelitis, your provider may try a procedure called plasma exchange. This procedure exchanges the plasma in your blood for new plasma. It removes harmful antibodies from the blood.

Depending on the type and severity of the effects of transverse myelitis, you may need physical therapy. A period of specialized in-patient care in a rehabilitation facility may be necessary.

The long-term effects of transverse myelitis vary among people. About 1/3 of people with transverse myelitis have full or near-full recovery, with most of their symptoms gone. Another third have fair recovery, retaining some of their symptoms. The last third recover poorly and have major physical disabilities.

When recovery from transverse myelitis occurs, it often starts from 2 to 12 weeks after you first have symptoms. It can take up to 2 years. Most people will only have a single episode of transverse myelitis. But a few people may have a recurrence. 

Some people who get transverse myelitis are left with permanent physical disabilities, such as muscle stiffness, loss of bowel or bladder function, muscle weakness, or even paralysis. If you have any of these impairments, physical therapy will likely be a very important part of your treatment. In this treatment, specialists will work with you to maintain or increase your strength, improve your coordination, and help you gain more control over bladder and bowel functions.

Another type of therapy is occupational therapy. This helps you learn new ways of doing everyday tasks, like bathing, in spite of your new physical limitations.

Finally, some people with physical disabilities often feel sad or depressed. If this happens to you, your provider may recommend that you see a mental health provider. Antidepressants and psychotherapy, or “talk therapy,” can help treat depression.

Some people recover fully from transverse myelitis within a few months or years. But others might continue to have long-term problems. Talk with your healthcare provider about when you need to call them.

Your healthcare provider will likely advise you to call him or her if any symptoms you are having become worse, including weakness, numbness or other changes in sensation, or changes in bladder or bowel control.

People who have serious long-term effects from transverse myelitis, such as paralysis or loss of bladder or bowel control, can also develop a number of other complications. Your provider might advise you to call if you have problems such as:

• Skin sores or infections.

• Trouble breathing.

• Fever or other signs of infection.

• Trouble urinating regularly or having severe constipation.

• Severe muscle cramps or spasms.

• Increasing pain.