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Transverse Myelitis

Transverse myelitis (TM) is a neurological condition produced by abnormal inflammation in the spinal cord, resulting in a block of the nerve impulses and neurologic symptoms. TM is a rare disease, with a frequency estimated to be five new cases for every one million people. TM can affect anybody, regardless of age, gender, or race.

Overview

Transverse myelitis (TM) is a neurological condition produced by abnormal inflammation in the spinal cord, resulting in block of the nerve impulses and neurologic symptoms. TM is a rare disease, with a frequency estimated to be five new cases for every one million people. TM can affect anybody, regardless of age, gender, or race.

Symptoms

Typical symptoms of TM include:

  • Back or neck pain
  • Weakness in the arms or legs
  • Muscle spasms
  • Numbness or tingling
  • Loss of bladder or bowel control

The distribution of symptoms depends on the location of the inflammation. Inflammation in the neck produces symptoms from the neck down. Inflammation in the mid-spine produces symptoms from the waist down. The severity of TM depends upon the severity and extent of the inflammation.

Symptoms usually develop over a period of several hours up to several weeks. Over this time, the symptoms become more severe, they may spread, and new symptoms may accumulate. Symptoms typically persist for weeks to months then improve over months. Recovery can range from minimal to complete. TM can be monophasic (occurring only once) or recurrent (with repeated episodes).

Cause

There are many potential causes of TM, including:

  • Idiopathic. Much of the time, a specific cause of TM is not identified
  • Multiple sclerosis: TM can develop as one type of MS attack (relapse), including the first MS attack. In general, TM in MS tends to be a less severe form.
  • Devic’s Neuromyelitis Optica, is a disorder related to MS that produces severe recurrent TM and optic neuritis (inflammation in the optic nerve that connects the eye to the brain).
  • Systemic inflammatory diseases. Diseases such as Systemic Lupus Erythematosus, Sjogren’s syndrome, or sarcoidosis can cause TM.
  • Infections. TM can develop in association with a variety of infections, both viruses (for example, herpes simplex, Epstein-Barr, influenza, and HIV) and bacteria (for example tuberculosis, syphilis, and Lyme).

Diagnosis

The first step to making the diagnosis of TM is for a physician to review the medical history and perform a physical examination. If this review suggests a spinal cord problem, making the diagnosis of TM involves 1) eliminating the possibility that a process other than inflammation is affecting the spinal cord, for example a tumor, a herniated disc, or abscess compressing the spinal cord, 2) confirming the presence of abnormal inflammation within the spinal cord, and 3) trying to identify the cause for the abnormal inflammation.

The initial test usually is an MRI scan of the spine to confirm the presence of inflammation in the cord and rule out some other cause of a spinal cord problem. If the MRI scan shows lesions (spots) in the spinal cord with the appearance of TM, a lumbar puncture often is performed to confirm inflammation and to help determine its cause, for example looking for MS or infection. An MRI scan of the brain may be performed looking for other lesions suggestive of MS. Finally, blood tests can also help identify the cause.

Treatment

Treatment of TM is aimed at relieving the abnormal inflammation with the goal of accelerating recovery, limiting tissue damage, and improving recovery. TM is treated most often with high-dose corticosteroids. Corticosteroids work by reducing inflammation and by reducing the activity of the immune system. If corticosteroids are ineffective, plasma exchange, intravenous gamma globulin, or other immune suppressing drugs sometimes are used. Management of the symptoms of TM, for example, pain, spasms, bladder or bowel problems also is an important aspect of management.

Recovery from TM is highly variable among individuals. Approximately one-third of people with TM experience good to complete recovery, another third experience fair recovery, and the remaining third have poor recovery. Most improvement occurs within the first three to six months, although some gradual improvement can continue for up to several years. For patients experiencing sequelae of TM, some daily activities can become challenging. Physical therapy, occupational therapy, and other rehabilitation approaches can help improve function.

For further information

Like most disorders, knowledge is an important tool to help manage TM and its complications. The following organizations can provide more information about TM:

The Transverse Myelitis Association
1787 Sutter Parkway
Powell, OH 43065-8806
614.766.1806
www.myelitis.org/

National MS Society
733 Third Avenue
New York, NY 10017-3288
www.nationalmssociety.org/

National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: Toll-free 800.352.9424
www.ninds.nih.gov/

© Copyright 1995-2009 Cleveland Clinic. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/30/2008...#8980

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