Causative & risk factors
The exact cause of transverse myelitis is not known. This condition usually develops following a viral infection. It can also occur as a sequel of other diseases like syphilis, Lyme’s disease, measles etc.
Transverse myelitis has been known to occur following vaccinations. Cases in which the cause cannot be found are termed as ‘idiopathic’.
Transverse myelitis can appear as the first symptom of multiple sclerosis.
Clinical presentation
Many patients complain of pain in the lower back, which may radiate to the legs, arms or around the torso. Abnormal sensations may be present in the leg such as tingling, burning, pricking etc. Due to sensory alteration, even a light touch on the limbs can produce severe pain or discomfort.
Patients usually complain of weakness in the arms and legs. There may be partial or total paralysis of the legs. Autonomic nervous system disruption affects the bowel and bladder function causing symptoms like increased frequency, sensation of incomplete evacuation and incontinence.
Other symptoms such as fever, headaches, loss of appetite etc. may be present.
About 1/3rd of the patients recover completely within a span of several months to 2 years. Another 1/3rd achieve a partial recovery whereas the remaining 1/3rd do not improve at all.
Investigations
Transverse myelitis is suspected on the basis of the patient’s medical history and a thorough neurological examination. Further investigations are aimed towards finding the cause of myelitis and detecting any structural lesions on the spinal cord.
MRI of the brain and spinal cord is a frequently performed investigation. A spinal tap (lumbar puncture) is performed to examine the CSF (cerebrospinal fluid).
A blood test to check for antibodies to neuromyelitis optica is carried out to rule out this condition. Other blood tests are carried out to eliminate the possibility of B12 deficiency, HIV infection etc.
Treatment
Transverse myelitis can be reversed if treatment begins early. It can take several months or up to 2 years. Failure to treat in the initial phase can cause permanent defects. Treatment available is supportive and symptomatic.
The patient is advised to rest for a few weeks at the onset of this disorder. Painkillers and corticosteroid drugs are prescribed to relieve the pain and inflammation. Plasma exchange therapy is tried in patients who do not respond to drug treatment.
Physical therapy is recommended to rehabilitate the patient. Transverse myelitis often causes anxiety and depression for which psychotherapy is recommended.
Recent updates
Several new drugs are being tested for their efficacy in treating transverse myelitis.
Statistics
In the United States, approximately 1,400 new cases of transverse myelitis are diagnosed annually.
