Transverse Myelitis and Multiple Sclerosis
What Is Transverse Myelitis (TM)?
- Pain is often the first symptom of TM, generally beginning in the lower back. The location of the spinal cord where the damage occurs determines which parts of the body are affected. The damage will affect function at that area and the areas below it.
Other early symptoms can include:- Sensitivity to touch — clothing or a light touch with a finger causes significant discomfort or pain
- Weakness in the arms and/or legs
- Sensory symptoms such as numbness, tingling, burning, tickling or prickling in the legs, feet and/or toes
- Bowel and bladder dysfunction — which may include an increased frequency of the urge to urinate or have bowel movements, loss of bowel or bladder control, difficulty urinating, constipation or the feeling of incomplete bowel evacuation
- Heightened sensitivity to changes in temperature or to extreme heat or cold
- Fatigue
- Researchers have not determined the exact cause of the spinal cord inflammation that leads to TM. There are several possible causes, including:
- Inflammation from an infection
- Systemic inflammatory autoimmune diseases
- Central nervous system diseases
- Idiopathic (no known cause)
Magnetic resonance imaging (MRI) - Blood tests to identify other possible causes of the symptoms such as systemic lupus erythematosus (lupus), HIV infection or vitamin B12 deficiency, and to check for antibodies (proteins in the blood) associated with other demyelinating diseases, including anti-AQP4 and anti-MOG antibodies.
- Lumbar puncture (spinal tap) to examine the fluid that surrounds the brain and spinal cord for white blood cells (indicating a possible infection) and to look for signs of diseases such as MS
- Spinal angiography, which involves injecting dye through a catheter to assess the blood vessels of the spinal cord for problems
The process of diagnosis includes:
- A complete medical history, including any history of recent viral, bacterial, fungal or parasitic infections or cancer
- A thorough neurological examination
- Magnetic resonance imaging (MRI)
- Blood tests to identify other possible causes of the symptoms such as systemic lupus erythematosus (lupus), HIV infection or vitamin B12 deficiency, and to check for antibodies (proteins in the blood) associated with other demyelinating diseases, including anti-AQP4 and anti-MOG antibodies.
- Lumbar puncture (spinal tap) to examine the fluid that surrounds the brain and spinal cord for white blood cells (indicating a possible infection) and to look for signs of diseases such as MS
- Spinal angiography, which involves injecting dye through a catheter to assess the blood vessels of the spinal cord for problems
TM occurs in adults and children of all races.
- Those assigned female at birth have a higher risk of TM than those assigned male.
- No genetic pattern is known. TM is not related to family history.
- The highest number of new cases in a given year occurs between ages 10 and 19, and between ages 30 and 39.
- The symptoms of TM can appear suddenly, developing over hours or several days. They can also develop more gradually over a period of 1 to 4 weeks.
Several different conditions cause TM, and so treatments vary. In addition to treating any underlying infection that may be causing TM, healthcare providers prescribe IV high-dose steroids to decrease inflammation right away. In addition, they may recommend plasma exchange (PLEX), intravenous immunoglobulin (IVIG) or other medications to suppress the immune system. The line of treatment depends on the root cause of the TM.Finally, long-term rehabilitation may help prevent or reduce disability. Even in patients with severe weakness, rehabilitation can help restore function and quality of life.
Some people affected by TM recover with minor or no problems. Others experience permanent impairments that affect their ability to perform ordinary tasks of daily living. Permanent neurological deficits could include severe weakness, spasticity (painful muscle stiffness or contractions), paralysis, incontinence and chronic pain. Aggressive physical therapy/rehabilitation is indicated after an episode of TM to aid with recovery.
Several organizations offer resources and information for people who live with TM and their families:
- The nonprofit organization Siegel Rare Neuroimmune Association (SRNA) serves people with ADEM, MOGAD, NMOSD, optic neuritis and TM and their families. They maintain a clinical care network and fund research.
- The Christopher & Dana Reeve Paralysis Resource Center (PRC) works to cure spinal cord injury by funding innovative research and to improve the quality of life for people living with paralysis through grants, information and advocacy. They also offer peer mentoring, local resources and Quality of Life grants.