Transverse Myelitis

A Cause of Sudden Paralysis in the Young

View of boy's back, close-up on spine
When the immune system attacks the spine, even the young can suffer sudden paralysis. valentina angiuli photografie/Moment/Getty Images

Imagine that within a day, you rapidly lost your ability to feel or move your legs, or even control your bladder or bowel movements. This terrifying scenario is what occurs to people with transverse myelitis.

Transverse myelitis affects between one to five people per million per year. While transverse myelitis is uncommon, it is devastating to the afflicted.

Like multiple sclerosis, transverse myelitis is an autoimmune disorder.

The body's own immune system confuses the nervous system for disease and attacks. The result is an inflammatory response at one level of the spinal cord, which can shut off communication between the brain and all parts below that level of the spinal cord.

As a result of this loss of communication, people with transverse myelitis can suffer from numbness, tingling, or weakness of part or all of their body below a certain level, most commonly within the thoracic spinal cord. While this usually impacts both sides of the body, unilateral syndromes such as Brown-séquard can also occur. Other effects can include dysautonomia or a loss of bladder or bowel control. Pain is not uncommon. Symptoms can develop quickly, often within 24 hours, though slower progression can also occur.

Transverse myelitis can be part of multiple sclerosis, and is sometimes the first problem in the disease. It may also be part of Devic's disease (neuromyelitis optica), another demyelinating disease that predominantly impacts the spinal cord and optic nerve.

Transverse myelitis is also found with rheumatologic disorders such as systemic lupus erythematosus, mixed connective tissue disease, Behcet's disease, sceroderma and Sjogren's syndrome.

In addition to the physical examination, neurologists use tests such as laboratory studies, magnetic resonance imaging and lumbar punctures to better understand the cause of someone's transverse myelitis.

An MRI usually shows abnormal signals at one more more segments of the spinal cord. About half of the time, a study of cerebrospinal fluid (CSF) obtained by a lumbar puncture will show signs of inflammation such as a high protein level. Additional tests can be run on CSF to evaluate for cancers or infections. Tests can be performed on blood samples to evaluate for rheumatological disorders.

The treatment of acute transverse myelitis is based off reducing inflammation in the spinal cord. The use of high dose corticosteroids is the most preferred method to accomplish this. There is actually only limited evidence to support this, due to the rareness of transverse myelitis. In other demyelinating diseases, however, such as optic neuritis, high dose IV steroids have been shown to shorten the duration of symptoms. In some cases, plasma exchange may also be useful. Less data exists to support the use of other treatments such as IVIg in the setting of transverse myelitis. After that, any concomitant disorder such as multiple sclerosis or a connective tissue disorder should also be addressed.

Most people with transverse myelitis will have an improvement within one to three months. About 40 percent of people with transverse myelitis will have some remaining problems after the initial period of improvement. Recurrence of the transverse myelitis is rare, but does sometimes occur. Physical and occupational therapy can be helpful in getting people back on their feet after an attack of transverse myelitis.

Sources:

Benjamin M. Greenberg, Treatment of Acute Transverse Myelitis and Its Early Complications. Continuum: Spinal Cord, Root, and Plexus Disorders Volume 17, Number 4, August 2011

AH Ropper, MA Samuels. Adams and Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009.

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