Transverse myelitis is a disease of the spinal cord that causes symptoms such as muscle pain and weakness; in the most severe cases these alterations can last a lifetime.
In this article we will describe what transverse myelitis is, what its main symptoms and causes are and how it can be treated.
What is transverse myelitis?
Myelitis is a disease consisting of inflammation of the spinal cord , whether this is the cause of the patient’s symptoms or a consequence of another central nervous system disorder.
The name “myelitis” comes from the fact that nerve fibers covered with myelin sheaths , a substance that insulates the axons and facilitates the transmission of electrochemical impulses between neurons, are often affected .
“Transverse myelitis” is the term used for this disease when inflammation occurs on both sides of a section of the spine. We speak of partial transverse myelitis when the inflammation extends to both sides of the spinal cord but incompletely.
In general, the damage is limited to a small area of the spine , although the severity of the myelitis varies from case to case. The interruption in the sending of signals along the spine causes various physical alterations and deficits.
Main symptoms and signs
The symptoms of transverse myelitis usually affect both sides of the body below the damaged section of the cord. Although the development of these symptoms usually occurs within hours or days, it is sometimes slower and can take weeks to fully develop.
In many cases, transverse myelitis is detected by the sudden appearance of intense, stabbing pains in the lower back and legs . Depending on the part of the spine affected, pain may occur in other parts of the body, such as the chest and abdomen.
2. Muscle weakness
Muscle weakness usually affects the legs, causing feelings of heaviness in the lower extremities and difficulty walking. If the damaged section is located high in the spine, weakness may also occur in the arms.
In the context of transverse myelitis, muscle paralysis occurs as a progression of weakness in the extremities , particularly in the legs. When the paralysis is partial we speak of paraparesis, while if it is complete the correct term is paraplegia.
4. Sensory disturbances
Abnormal sensations that may occur as a result of myelitis include tingling, numbness, itching, burning, and sensitivity to intense heat and cold. The most commonly affected body parts are the legs, torso, and genitals. Sensory deficits are also common.
5. Sphincter dysfunction
The alteration in the function of the bladder and intestines is manifested in the presence of urinary incontinence, difficulties in urinating and defecating and constipation.
Causes of this disease
Most cases of transverse myelitis occur as a result of disorders that affect the nervous system. However, sometimes there is no identifiable cause; in these cases we speak of “idiopathic transverse myelitis”.
1. Immune system disorders
There are many immune disorders that are related to inflammation of the spinal cord. Among these we highlight post-infectious and post-vaccine reactions and multiple sclerosis, to which we dedicate a separate section.
Transverse myelitis may also occur as a result of autoimmune disorders such as systemic lupus erythematosus, optic neuromyelitis, and Sjogren’s syndrome.
2. Multiple sclerosis
Multiple sclerosis is a particularly common immune disorder that results in the destruction of the myelin sheaths surrounding the axons of the central nervous system. When this disease is present it is common for transverse myelitis to appear as one of its first signs.
3. Viral and other infections
Viral infections are a common cause of transverse myelitis, which usually occurs during the recovery period. Herpes viruses such as chickenpox and cytomegalovirus are some of the most common in this regard.
In addition, infections by bacteria (such as syphilis and tuberculosis), fungi (such as cryptococcus), and parasites (such as toxoplasmosis) can also cause inflammation of the spine. However, this problem is more common in viral infections.
4. Other inflammatory diseases
Systemic lupus erythematosus, mixed connective tissue disease, sarcoidosis, scleroderma, Sjogren’s syndrome, among other diseases, can also cause inflammation of spinal cord nerve fibers. In many cases these disorders are related to the immune system .
Treatment of transverse myelitis
Although transverse myelitis can cause chronic problems, if treatment is started early, symptoms and signs usually subside within weeks, although it can take almost two years to fully subside. The prognosis is worse if there is no improvement after about five months of treatment.
The treatment of transverse myelitis usually involves the administration of medications combined with physical rehabilitation therapy , which aims to improve muscle strength and coordination. Sometimes it is necessary to use assistive devices, such as crutches or wheelchairs, temporarily or permanently.
Some of the most commonly used drugs in the treatment of myelitis are intravenous corticosteroids such as methylprednisolone and dexamethasone , which can reduce inflammation in the cord. The specific medications used will depend on the cause, so if the illness is due to a virus, antiviral medications will be given.
When the body does not respond adequately to corticosteroids, plasma exchange therapy (plasmapheresis) can be applied. This involves removing blood plasma and replacing it with special fluids. This is intended to remove the antibodies responsible for inflammation of the spinal cord.
In addition, drugs are frequently administered to treat secondary symptoms; for example, analgesics and muscle relaxants are used to reduce pain , and if sexual or mood disorders are present, specific drugs can be prescribed for these disorders.