Understanding transverse myelitis

Transverse myelitis is a neurological condition where the spinal cord is inflamed. It can affect people of any age, gender or race. The spinal cord carries nerve signals to and from the brain through nerves that extend from each side of the spinal cord and connect to nerves elsewhere in the body. With transverse myelitis the fatty insulating substance that covers nerve cell fibres, called myelin, is destroyed.

The resulting inflammation interrupts the communication between nerve fibres in the spinal cord and the rest of the body. This leads to symptoms that include pain, sensory problems, weakness in the legs and bladder and bowel problems.

Although some people recover from transverse myelitis with minor or no residual problems, the healing process may take months or years. Others may suffer permanent damage that impacts their ability to perform ordinary tasks. Some will have only one episode of transverse myelitis; others may have a recurrence, especially if an underlying illness caused the disorder.

Causes of transverse myelitis

There are several causes of transverse myelitis:

• Immune system disorders – These appear to play an important role in causing damage to the spinal cord.  These include: multiple sclerosis, post-infectious or post-vaccine autoimmune phenomenon and abnormal immune response to an underlying cancer that damages the nervous system
• Viral infections – It is often difficult to know whether direct viral infection or a post-infectious response to the infection causes the transverse myelitis. Associated viruses include herpes viruses, herpes simplex, cytomegalovirus, and Epstein-Barr; flaviviruses such as West Nile and Zika; influenza, echovirus, hepatitis B, mumps, measles and rubella.
• Bacterial infections – such as syphilis, tuberculosis, actinomyces, pertussis, tetanus, diphtheria and Lyme disease. Bacterial skin infections, middle-ear infections, campylobacter jejuni gastroenteritis and mycoplasma bacterial pneumonia have also been associated with the condition.
• Fungal infections – in the spinal cord, including Aspergillus, Blastomyces, Coccidioides and Cryptococcus.
• Parasites – including Toxoplasmosis, Cysticercosis, Shistosomiasis, and Angtiostrongyloides.
• Other inflammatory disorders – that can affect the spinal cord, such as sarcoidosis, systemic lupus erythematosus, Sjogren’s syndrome, mixed connective tissue disease, scleroderma and Bechet’s syndrome.
• Vascular disorders – such as arteriovenous malformation, dural arterial-venous fistula, intra spinal cavernous malformations or disk embolism.

Treatment of transverse myelitis

Treatments are designed to address infections that may cause the disorder, reduce spinal cord inflammation and manage and alleviate symptoms. Initial treatments and management of the complications of transverse myelitis include:

• Intravenous corticosteroid drugs – may decrease swelling and inflammation in the spine and reduce immune system activity.
• Plasma exchange therapy – (plasmapheresis) may be used for people who don’t respond well to intravenous steroids.
• Intravenous immunoglobulin (IVIG) – is a treatment thought to reset the immune system. IVIG is a highly concentrated injection of antibodies pooled from many healthy donors that bind to the antibodies that may cause the disorder and remove them from circulation.
• Pain medicines – that can lessen muscle pain include acetaminophen, ibuprofen, and naproxen.
• Antiviral medications – may help those individuals who have a viral infection of the spinal cord.
• Medications can treat other symptoms and complications – including incontinence, painful muscle contractions called tonic spasms, stiffness, sexual dysfunction and depression.

For further information, see the National Institute of Neurological Disorders and Stroke website