Summary about Disease
Transverse myelitis (TM) is a rare neurological disorder caused by inflammation of the spinal cord. This inflammation damages the myelin, the insulating material covering nerve fibers, disrupting the communication between nerves in the spinal cord and the rest of the body. This disruption can cause pain, muscle weakness, paralysis, sensory problems, and bowel and bladder dysfunction. TM can result in long-term disabilities.
Symptoms
Symptoms of transverse myelitis can develop rapidly (over hours) or gradually (over days to weeks). They may include:
Pain: Spinal pain, often in the lower back, may radiate down the legs or arms.
Weakness: Muscle weakness in the arms or legs, sometimes progressing to paralysis.
Sensory Alterations: Numbness, tingling, coldness, burning, or heightened sensitivity to touch. A band-like sensation of tightness around the chest or abdomen is also possible.
Bowel and Bladder Dysfunction: Urinary urgency, incontinence, difficulty urinating, constipation, or bowel incontinence.
Sexual Dysfunction: Common due to the spinal cord damage.
Causes
The exact cause of transverse myelitis is often unknown (idiopathic). However, potential triggers include:
Viral Infections: Many viruses have been linked to TM, including herpes viruses (chickenpox, shingles), enteroviruses (polio, Coxsackievirus), Epstein-Barr virus, HIV, and West Nile virus.
Bacterial Infections: Lyme disease, syphilis, and mycoplasma infections.
Autoimmune Disorders: Multiple sclerosis (MS), neuromyelitis optica (NMO), systemic lupus erythematosus (SLE), Sjogren's syndrome, and sarcoidosis.
Inflammatory Disorders: Can occur after inflammatory disorders.
Vaccinations: Rarely, TM has been reported after certain vaccinations.
Medicine Used
Treatment for transverse myelitis focuses on reducing inflammation and managing symptoms. Medications may include:
Corticosteroids: Such as intravenous methylprednisolone, to reduce inflammation in the spinal cord.
Plasma Exchange Therapy (PLEX): Used to remove harmful antibodies from the blood, especially in cases linked to autoimmune disorders.
Antiviral Medications: If a viral infection is suspected as the cause.
Pain Relievers: Over-the-counter or prescription pain medications to manage pain.
Muscle Relaxants: To relieve muscle spasms.
Medications to Manage Bowel and Bladder Dysfunction: Such as stool softeners, laxatives, or medications to help with urinary retention or incontinence.
Medications to Treat Depression: Such as antidepressants, as depression is common with chronic conditions like TM.
Is Communicable
Transverse myelitis itself is not communicable. However, if the transverse myelitis is caused by an infection (viral or bacterial), that underlying infection *may* be communicable, depending on the specific infectious agent. The TM itself is an inflammatory response and not directly transmitted from person to person.
Precautions
Since the exact cause of TM is often unknown, it's difficult to take specific precautions to prevent it. General health practices, such as:
Vaccination: Staying up-to-date with recommended vaccinations can help prevent infections that may trigger TM.
Infection Control: Practicing good hygiene (handwashing) can reduce the risk of infections.
Managing Autoimmune Conditions: Individuals with autoimmune disorders should work with their healthcare providers to manage their condition effectively.
How long does an outbreak last?
The acute phase of transverse myelitis typically lasts from days to weeks. The duration of recovery and long-term outcomes vary significantly. Some individuals experience significant recovery, while others have permanent disabilities. The severity of the initial inflammation and the promptness of treatment can influence the recovery period. Some people have a single episode, while others might experience recurrent episodes, especially if associated with conditions like MS or NMO.
How is it diagnosed?
Diagnosis of transverse myelitis involves:
Medical History and Physical Examination: Assessing symptoms, neurological function, and medical history.
MRI of the Spinal Cord: To visualize inflammation or lesions in the spinal cord and rule out other conditions.
Lumbar Puncture (Spinal Tap): To analyze cerebrospinal fluid (CSF) for signs of infection, inflammation, or abnormal antibodies.
Blood Tests: To screen for underlying infections, autoimmune disorders, and other conditions that may be associated with TM.
Evoked Potentials: To assess the transmission of electrical signals along nerve pathways.
Timeline of Symptoms
Initial Phase (Days to Weeks): Rapid or gradual onset of back pain, muscle weakness, sensory changes, and bowel/bladder dysfunction.
Acute Phase (Weeks to Months): Symptoms stabilize, and the severity becomes apparent. Treatment is initiated.
Recovery Phase (Months to Years): Gradual improvement in symptoms, with some individuals experiencing significant recovery while others have persistent deficits. The degree of recovery varies greatly. Some may experience ongoing pain, spasticity, or bowel/bladder issues.
Chronic Phase (Long-term): For those with persistent deficits, management focuses on rehabilitation, symptom management, and preventing complications.
Important Considerations
Early Diagnosis and Treatment: Prompt diagnosis and treatment with corticosteroids or plasma exchange therapy are crucial to minimize spinal cord damage and improve outcomes.
Rehabilitation: Physical therapy, occupational therapy, and other rehabilitation services are essential for maximizing functional recovery and adapting to any remaining deficits.
Long-Term Management: Regular follow-up with a neurologist or rehabilitation specialist is important to monitor for complications, manage symptoms, and adjust treatment as needed.
Emotional Support: Living with transverse myelitis can be challenging. Support groups, counseling, and mental health services can help individuals cope with the emotional and psychological aspects of the condition.
Differentiation from Other Conditions: Accurately distinguishing TM from other conditions with similar symptoms, like multiple sclerosis or spinal cord compression, is important for correct management.