How is transverse myelitis treated?

Transverse myelitis is a relatively rare disease, and so there are no well-defined randomized trials of treatment for this disease. Most of what we know about treatment for TM comes from case studies or studies of groups of treated patients.

In most cases, hospitalization is required for an attack of TM due to the severity of the disorder. At this time, intravenous methylprednisolone is the front-line treatment for an attack of TM. Usually, the drug is given over five to seven days, followed by a tapering dose of steroids.

The aim of the treatment is to reduce swelling and irritation and speed recovery from the disease. There are possible side effects with steroid treatment; in the short term, these may include:

  • Increased blood glucose
  • Low potassium
  • Sleep disturbance
  • Mood changes (irritability, crying, anxiety)
  • Weight gain
  • Flushed cheeks
  • Facial swelling
  • A metallic taste (when using IV Solu-Medrol®)

Long-term complications of steroid treatment include:

  • Susceptibility to infection
  • Osteoporosis
  • Development of cataracts
  • Personality change
  • Obesity
  • Skin changes
  • Aseptic necrosis, or injury to the shoulder or hip joint. Aseptic necrosis is rare.

Another approach to treating transverse myelitis is a process called plasmapheresis. The process seems to effectively remove antibodies by circulating blood through a machine, reducing immune system activity.

Plasmapheresis usually takes a few hours and is done every other day for 10 to14 days, often as part of a hospital stay. Five to seven plasmapheresis treatments are usually needed to treat TM. You might have to have a central venous catheter put in to allow blood to be removed from the system rapidly. Risks of plasmapheresis include the discomfort involved in withdrawing blood and placing a catheter, a tendency to bleed due to a reduction in platelets (sometimes), and infections.

If lupus or another disorder is causing the TM, treatment may take longer. In general, transverse myelitis that is not caused by another disorder is a one-time disease and does not require continuing treatment other than whatever rehabilitation is necessary for the best recovery possible.

Last reviewed by a Cleveland Clinic medical professional on 01/28/2019.

References

  • The Transverse Myelitis Association. Transverse Myelitis. Accessed 4/2/2019.
  • National Institute of Neurological Diseases and Stroke. Transverse Myelitis Fact Sheet. Accessed 4/2/2019.
  • Ropper AH, Samuels MA, Klein JP. Chapter 36. Multiple Sclerosis and Other Inflammatory Demyelinating Diseases. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e. New York, NY: McGraw-Hill; 2014. library.ccf.org. Accessed 4/2/2019.

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