TRANSVERSE MYELITIS (TM)

BMR 3201 CLINICAL NEUROSCIENCES

2 DEFINITION A neurological disorder caused by inflammation across both sides of one level,
or segment, of the spinal cord. Myelitis refers to inflammation of the spinal
cord; transverse simply describes the position of the inflammation (across the width of the spinal
cord). Attacks of inflammation can damage or destroy myelin. This damage causes nervous
system scars that interrupt communications between the nerves in the spinal cord and the rest of
the body.

3 AETIOLOGY Viral and other infections of the respiratory or gastrointestinal tract have been
implicated in TM. In most cases, this inflammatory disorder appears after recovery from the viral
infection. Multiple sclerosis is a disorder in which the immune system destroys myelin
surrounding nerves in your spinal cord and brain. TM can be the first sign of multiple sclerosis or
represent a relapse. TM as a sign of multiple sclerosis usually manifests on only one side of your
body. The exact reason for transverse myelitis is not known. In some cases, no cause can be
found for transverse myelitis.

4 AETIOLOGY Neuromyelitis optica (Devic's disease) is a condition that causes inflammation

and loss of myelin around the spinal cord and the nerve in the eye that transmits information to
your brain. TM associated with neuromyelitis optica usually affects both sides of your body.
Autoimmune disorders affecting other body systems likely contribute to transverse myelitis in
some people. These disorders include lupus, which can affect multiple body systems, and
Sjogren's syndrome.

5 AETIOLOGY Vaccinations for infectious diseases — including hepatitis B, measles-mumps-

rubella, and diphtheria-tetanus vaccines — have occasionally been implicated as a possible
trigger.

6 PATHOPHYSIOLOGY The cause is not known but one major theory states that immune-
mediated inflammation is present as the result of exposure to a viral antigen. The diarrhea-
causing bacteria Campylobacter jejuni is also a reported cause of transverse myelitis.

7 CLINICAL FEATURES
Initial symptoms usually include localized lower back pain, sudden paresthesias (abnormal
sensations such as burning, tickling, pricking, or
tingling)in the legs, sensory loss, and paraparesis (partial paralysis of the legs).
Paraparesis may progress to paraplegia (paralysis of the legs and lower part of the trunk).
Urinary bladder and bowel dysfunction is common.

8 CLINICAL FEATURES Many patients also report experiencing muscle spasms, a

general feeling of discomfort, headache, fever, and loss of appetite.
Depending on which segment of the spinal cord is involved, some patients may experience
respiratory problems as well.
From this wide array of symptoms, 4 classic features of TM emerge: (1) weakness of the legs an
d arms, (2) pain, (3) sensory alteration, and (4) bowel and bladder dysfunction.
9 MEDICAL MANAGEMENT

10 DIAGNOSIS Physicians diagnose TM by taking a medical history and performing a thorough

neurological examination. Since it is often difficult to distinguish between a patient with an
idiopathic form of TM and one who has an underlying condition, physicians must first eliminate
potentially treatable causes of the condition.

11 DIAGNOSIS When a spinal cord problem is suspected, physicians seek first to rule out
structural lesions (damaged or abnormally functioning areas) that could cause spinal cord
compression or otherwise affects its function. Such potential lesions include tumors, herniated or
slipped discs, stenosis (narrowing of the canal that holds the spinal cord), abscesses, and
abnormal collections of blood vessels.

12 TREATMENT As with many disorders of the spinal cord, no effective cure currently exists
for people with transverse myelitis. Treatments are designed to reduce spinal cord inflammation
and manage and alleviate symptoms. Physicians often prescribe anti-inflammatory corticosteroid
therapy soon after the diagnosis is made in order to decrease inflammation and hopefully
improve the chances and speed of neurological recovery.

13 TREATMENT Several therapies target the acute signs and symptoms of transverse myelitis:
Intravenous steroids. These help to reduce the inflammation in the spinal column. Plasma
exchange therapy. People who don't respond to intravenous steroids may undergo plasma
exchange therapy. This therapy involves removing plasma and replacing the plasma with special
fluids.

14 TREATMENT Antiviral medication. Some people who have a viral infection of the spinal
cord may be treated with antiviral medication. Pain medication. Chronic pain is a common
complication of transverse myelitis. Medications that may lessen muscle pain include common
pain relievers, including acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others)
and naproxen sodium (Aleve).

15 TREATMENT Medications to treat other complications. Doctors may prescribe other

medications as needed to treat problems such as muscle spasticity, urinary or bowel dysfunction,
depression, or other complications associated with transverse myelitis. Medications to prevent
recurrent attacks of TM. People who have positive results for antibodies associated with
neuromyelitis optica require ongoing immunosuppressive medications such as corticosteroids to
reduce their chances of having recurrent attacks of TM or from developing optic neuritis.

16 TREATMENT Physical Therapy:

Therapists treat disabilities that result from motor and sensory impairments. Their aim is to help
patients increase their strength and endurance, improve coordination, reduce spasticity and
muscle wasting in paralyzed limbs, and regain greater control over bladder and bowel function
through various exercises. They also teach paralyzed patients techniques for using assistive
devices such as wheelchairs, canes, or braces as effectively as possible.
17 TREATMENT Paralyzed patients also learn ways to avoid developing painful pressure sores
on immobilized parts of the body, which may lead to increased pain or systemic infection. In
addition, therapists are involved in pain management.

18 TREATMENT Occupational Therapy:

Therapists help individuals learn new ways to maintain or rebuild their independence by
participating in meaningful, self-directed, goal-oriented, everyday tasks such as bathing and
dressing. They teach people how to function at the lightest level possible, by developing
compensatory strategies, suggesting changes in their homes to improve safety, changing
obstacles in their environment that interfere with normal activity, and instructing on how to use
assistive devices.

19 TREATMENT Psychotherapy.
A psychotherapist can use talk therapy to treat anxiety, depression, sexual dysfunction, and other
emotional or behavioral issues that may be related to someone coping with transverse myelitis.

20 PROGNOSIS Recovery from transverse myelitis usually begins within 2 to 12 weeks of the
onset of symptoms and may continue for up to 2 years (and in some cases longer). However, if
there is no improvement within the first 3 to 6 months, complete recovery is unlikely (although
incomplete recovery can still occur, which underlines the significant need for aggressive physical
therapy and rehabilitation).

21 REFERENCE © Mayo Foundation for Medical Education and Research. “Transverse

Myelitis Fact Sheet,” NINDS. NIH Publication No Transverse Myelitis Association