Summary about Disease
Nutritional myelopathy is a non-inflammatory condition affecting the spinal cord due to nutritional deficiencies, most commonly vitamin B12 (cobalamin) deficiency, but also can be caused by vitamin E deficiency, and copper deficiency. It leads to progressive neurological dysfunction, particularly affecting the posterior and lateral columns of the spinal cord. The condition is potentially reversible with prompt diagnosis and appropriate nutritional supplementation, but irreversible damage can occur if left untreated.
Symptoms
Symptoms typically develop gradually and can include:
Sensory: Tingling, numbness, and burning sensations in the hands and feet (peripheral neuropathy). Loss of vibration and position sense (proprioception), leading to difficulty with balance and coordination.
Motor: Weakness in the legs, stiffness, and difficulty walking. Spasticity (increased muscle tone) may develop.
Other: Vision problems (optic neuropathy in B12 deficiency). Cognitive difficulties. Bladder and bowel dysfunction can occur in severe cases.
Causes
The primary causes are nutritional deficiencies:
Vitamin B12 Deficiency: This is the most common cause. It can result from inadequate dietary intake (especially in vegans), malabsorption due to pernicious anemia (lack of intrinsic factor), gastric surgery, or certain medications (e.g., metformin, proton pump inhibitors).
Vitamin E Deficiency: Can occur due to malabsorption syndromes (e.g., cystic fibrosis, celiac disease), or genetic disorders affecting vitamin E transport.
Copper Deficiency: Can occur due to excessive zinc intake (zinc interferes with copper absorption), malabsorption, or bariatric surgery.
Other Nutritional Deficiencies Folate deficiency, though less common than vitamin B12, can also contribute.
Medicine Used
Treatment focuses on correcting the underlying nutritional deficiency:
Vitamin B12 Deficiency: Vitamin B12 supplementation, usually with intramuscular injections of cyanocobalamin or hydroxocobalamin, especially initially to bypass absorption issues. Oral supplementation can be used for maintenance after levels have been restored.
Vitamin E Deficiency: Vitamin E supplementation, usually with oral alpha-tocopherol.
Copper Deficiency: Copper supplementation, typically with oral copper salts.
Supportive medications: Medications for pain management (neuropathic pain medications like gabapentin or pregabalin), spasticity (muscle relaxants like baclofen), and bladder/bowel dysfunction might be used to manage symptoms.
Addressing underlying cause of deficiency: Management of underlying malabsorption conditions or dietary adjustments
Is Communicable
No, nutritional myelopathy is not communicable. It is caused by dietary deficiencies and not by infectious agents.
Precautions
Preventing nutritional myelopathy involves:
Balanced Diet: Consuming a diet rich in essential vitamins and minerals.
Supplementation: Individuals at risk of deficiencies (e.g., vegans, those with malabsorption issues, elderly) should consider appropriate supplementation after consulting with a healthcare professional.
Monitoring: Regular monitoring of vitamin B12, vitamin E, and copper levels in at-risk individuals.
Addressing Underlying Conditions: Properly managing underlying medical conditions that can lead to malabsorption.
Awareness: Being aware of the symptoms and seeking prompt medical attention if they develop.
How long does an outbreak last?
Nutritional myelopathy is not an "outbreak" disease. It is a chronic condition that develops over time due to ongoing nutritional deficiencies. The duration of symptoms depends on how long the deficiency has been present and how quickly it is addressed with appropriate treatment. If treated early, some recovery is possible, but long-standing deficiencies can lead to irreversible damage.
How is it diagnosed?
Diagnosis typically involves:
Medical History and Physical Exam: Assessing symptoms, dietary history, and risk factors. A neurological examination is crucial to assess motor and sensory function.
Blood Tests: Measuring levels of vitamin B12, vitamin E, copper, and other relevant nutrients. Testing for methylmalonic acid (MMA) and homocysteine can help identify B12 deficiency even with normal B12 levels. Complete Blood Count (CBC) may show macrocytic anemia.
Imaging Studies: MRI of the spinal cord is often performed to rule out other causes of myelopathy and may show characteristic changes associated with nutritional deficiencies, though these findings are not always specific.
Electrodiagnostic Studies: Nerve conduction studies and electromyography (EMG) can help assess peripheral nerve function.
Timeline of Symptoms
The onset of symptoms is usually gradual and progressive.
Early Stage: Subtle sensory changes (tingling, numbness) in the hands and feet may be the first signs. These may be intermittent at first. Mild gait imbalance may be present.
Progressive Stage: Symptoms worsen over weeks to months. Sensory deficits become more pronounced. Weakness and stiffness in the legs develop, making walking increasingly difficult. Balance problems become more significant.
Advanced Stage: If untreated, severe weakness, spasticity, bladder/bowel dysfunction, and cognitive problems can develop. The rate of progression varies depending on the severity and duration of the deficiency.
Important Considerations
Differential Diagnosis: It is important to rule out other causes of myelopathy, such as multiple sclerosis, spinal cord compression, infections, and other metabolic disorders.
Prompt Treatment: Early diagnosis and treatment are crucial to prevent irreversible neurological damage.
Individualized Approach: Treatment plans should be tailored to the specific nutrient deficiency and the individual's needs.
Monitoring Treatment Response: Regular follow-up with a healthcare professional is necessary to monitor response to treatment and adjust the plan as needed.
Long-Term Management: Some patients may require lifelong supplementation and monitoring to prevent recurrence of the deficiency.
Dietary Changes: Education on appropriate dietary changes to maintain adequate nutrient intake.
Neurological Rehabilitation: Physical therapy and occupational therapy can help improve strength, balance, and coordination and maximize functional independence.