What is Transverse Myelitis?
Transverse Myelitis (TM) is a rare inflammatory disease involving inflammation of the spinal cord. Because of its relationship to the spinal cord, TM is accompanied by various signs of neurological dysfunction in the motor and sensory tracts. Often, individuals suffering from TM experience altered sensation, weakness, and occasionally urinary or bowel dysfunction.
The word transverse refers to the dysfunction across the spinal cord, although not all cases of TM may extend across the full cord. Myelitis refers to an inflammation in the spinal cord. The location of the myelitis along the spinal cord correlates with the signs and symptoms an individual may experience.
What are common symptoms of TM?
Individuals with Transverse Myelitis typically present with one (or more) of the following symptoms:
- Weakness of the legs and/or arms: Stumbling, dragging one foot, or the feeling that limbs are heavier than normal.
- Sensory Alteration: Numbness, tingling, coldness, or burning of the skin. Up to 80% of patients experience heightened sensitivity to touch.
- Pain: Can be localized to the back or present as sharp shooting pain radiating in the arms, legs, or torso. Conversely, patients may lose the ability to experience pain or respond to temperature.
- Bowel/Bladder Dysfunction: Can present as increased urgency to urinate or defecate, or as incontinence, difficulty voiding, or constipation.
What causes TM?
While the exact cause of Transverse Myelitis is unknown, it has been reported to occur after infections and vaccinations. It has also been reported to occur in the setting of other autoimmune disorders.
How is TM diagnosed?
In making a clinical diagnosis of TM, physicians consider signs, symptoms and neurological examination to hone the diagnosis.
Doctors may work to rule out the possibility of trauma or pressure from a foreign mass with spinal cord evaluation. Following this examination, if the possibility of herniated or slipped discs, stenosis, abscesses, abnormal collections of blood vessels, and vitamin deficiencies have been ruled out, physicians may begin an additional round of testing. Magnetic Resonance Imaging (MRI) and lumbar punctures (spinal tap) can aid in diagnosing TM.
How is TM treated?
For some patients, intravenous steroids help to reduce inflammation in the spinal column. For patients who do not respond to steroids, clinicians may order plasma exchange therapy.
In addition, your doctor may prescribe medication as needed to treat pain, muscle spasticity, urinary or bowel dysfunction, depression, or other complications associated with the disease.
Your doctor may also recommend physical therapy, occupational therapy, or psychotherapy to aid in long-term recovery and care.
Living with TM
Following the acute phase of the illness, rehabilitative care is important for recovery of functional skills and preventing secondary complications. As with any spinal cord injury, physical issues including bowel and bladder management, sexual dysfunction, maintenance of skin integrity, spasticity, difficulty with activities of daily living, mobility, and pain are possible. Because these problems can be complicated by inactivity, it is important to begin occupational and physical therapies early in the recovery process.
Additionally, patients will need to manage the ongoing issues of ordering equipment, reentry to school or work, re-socialization into the community, and coping with the psychological effects of this condition. Family education is especially important during the early recovery period to develop a strategy for dealing with the challenges to independence that accompany this condition.