Your spinal cord is one of the main components of your body’s central nervous system (CNS). It’s formed out of millions of bundles of nerve tissues that run from the base of your brain down your spine to the lower part of your back. Since the spinal cord is responsible for the communication between your brain and your body, there are several mechanisms in place to keep it safe. The first layer of protection are layers of membrane—myeline—that surround the spinal cord. These are then covered by your back bones—vertebrae—to help keep the spinal cord protected from external injury. Unfortunately, certain disorders and degenerative diseases can cause problems with the spinal cord from within, which disrupts communication with the brain and body. One of these disorders is called transverse myelitis. To better understand the symptoms, causes, and prognosis, here we’ll answer a common question of those afflicted: what is transverse myelitis?
Understanding Transverse Myelitis
Transverse myelitis is a disorder that’s caused by inflammation of the spinal cord. This tends to occur on one section of the spinal cord, but inflammation surrounds the affected area on both sides. This can create a band-like sensation that wraps around the trunk of the individual affected, as transverse myelitis disrupts essential communication that occurs between every system in your body. Like other disorders that affect the spinal cord, more research is currently being done to better understand how and why the body’s immune system attacks protective myelin. Glial cell studies, genetic studies, neuroimaging, and brain-machine interfaces are currently being explored to help create a better prognosis for this disorder.
Signs and Symptoms of Transverse Myelitis
There are two primary classifications of symptoms in transverse myelitis. Acute symptoms occur between hours and a few days. Subacute symptoms are more gradual and tend to develop and become more noticeable between one and four weeks. Symptoms vary depending on which segment of the spinal cord is affected, but there will be an effect on function extending from the location downwards. Therefore, the higher the affected area is located on the spinal cord, the more serious the damage will be. Typically, there are four symptoms that are characteristics of transverse myelitis. They are as follows.
Weakness in Arms or Legs
Most cases of transverse myelitis affect the upper back, which leads to a rapid decline in muscle strength of the legs. Symptoms may begin with a weak feeling or heaviness in the legs and quickly become more noticeable. When transverse myelitis affects upper sections of the spinal cord, closer to the neck, this weakness will also occur in the arms. Depending on the severity of the disorder, weakness can progress to partial or total paralysis of the afflicted area. In some instances, paralysis is permanent.
Sensations Alterations
It’s also common for individuals suffering from transverse myelitis to experience abnormal sensations throughout their body. These sensations may include feelings of numbness, tingling, pricking, burning, or a cold feeling across various areas of the body. These can also include an increase in light or touch sensitivity, abnormal sensations in the genital region, and complete sensory loss.
Pain
Many cases of transverse myelitis begin with a sharp pain that begins in the lower back and travels down your legs, arms, or engulfs the chest area and abdominal region. Those who have experienced pain associated with this disorder describe it as a shooting pain. The location of spinal cord that’s affected by the inflammation is what determines where an individual feels pain.
Bladder and Bowel Problems
Due to inflammation, individuals may experience problems with their bladder and bowels. Some common issues include urinary incontinence, constipation, and an increased need to use the bathroom. Since these symptoms can be characteristics of many common urologic conditions, seeing a doctor for the proper diagnosis is essential.
Other symptoms of transverse myelitis that may occur include discomfort, loss of appetite, muscle spasms, headache, fever, respiratory problems, sexual dysfunction, depression, and anxiety. Seek medical attention immediately if you or a loved one experience any of the symptoms associated with transverse myelitis.
Causes of Transverse Myelitis
In about 60% of cases of transverse myelitis, the cause remains unknown; the other 40% are associated with autoimmune disorders, infections, and inflammatory conditions. When a cause is unable to be determined, the diagnosis is called idiopathic transverse myelitis.
Immune System Disorders
Research shows that many cases of transverse myelitis are caused by immune system disorders such as multiple sclerosis, neuromyelitis optica, post-infectious or post-vaccine autoimmune phenomenon, abnormal immune responses to cancers, HIV, and other autoimmune disorders. If you have an autoimmune disorder, discuss your risk factors with your doctor.
Viral, Bacterial, and Fungal Infections
Certain viruses, bacteria, or fungal infections can also lead to the development of transverse myelitis. Viruses that can trigger inflammation include herpes viruses, Epstein-Barr, West Nile, Zika, influenza, hepatitis B, measles, mumps, and rubella. Bacterial infections that can trigger transverse myelitis include syphilis, tuberculosis, pertussis, tetanus, diphtheria, Lyme disease, and certain bacterial skin infections. Fungal infections that occur in the spinal cord can also trigger onset. In some individuals, certain parasites may be responsible for the development of transverse myelitis.
Inflammatory Conditions
Inflammatory conditions that can lead to transverse myelitis include sarcoidosis, lupus, Sjogren’s syndrome, scleroderma, Bechet’s syndrome, and mixed connective tissue disease. This does not represent an exhaustive list of all conditions that could trigger inflammation of the spinal cord, so always discuss any concerns with your doctor.
Diagnosing transverse myelitis requires an individual’s medical history, neurological exams, blood tests, lumbar tests, and magnetic resonance imaging to rule out other causes of symptoms and determine a diagnosis. If the tests point to no other disorder or disease, transverse myelitis is often confirmed.
Treatments, Long-Term Recovery, and Care
Individuals with transverse myelitis usually only have one episode, but complications can persist indefinitely. Some of the most common complications include pain, stiffness, partial or total paralysis, sexual dysfunction, and depression or anxiety. To reduce inflammation and help alleviate symptoms, it’s important to seek treatment as soon as possible.
Medications
Different types of medications can be used in the treatment and prevention of complications for those who have suffered from transverse myelitis. Intravenous corticosteroid drugs work to decrease inflammation in the spine while inhibiting immune system activity. Intravenous immunoglobulin (IVIG) can be used to reset the immune system by flushing out antibodies, pain medications are given to help individuals cope, and antivirals are prescribed if there’s evidence of infection within the spinal cord. If you’re suffering from complications, your doctor will prescribe additional medications specific to your needs.
Plasma Exchange Therapy
Plasma exchange therapy can be used as an alternative to steroids to help decrease immune system activity through the extraction of plasma. Plasma is taken from the blood and then replaced with alternative fluids to help remove the antibodies that are responsible for transverse myelitis.
Additional Therapy
To help improve long-term recovery, your doctor will likely recommend a combination of physical therapy, occupational therapy, and psychotherapy. Physical therapy can help you improve your overall muscles strength and regain coordination. In the case of permanent damage or paralysis, a physical therapist can help you navigate different types of assistive devices to regain your independence and adjust to a new lifestyle. Occupational therapy helps individuals learn how to perform daily tasks and activities with physical limitations. Psychotherapy is beneficial to everyone who is affected by transverse myelitis, as it can help alleviate anxiety, depression, sexual dysfunction, and coping issues after your diagnosis. It may also be beneficial to join a support group to connect with other individuals who are suffering from the lingering effects of transverse myelitis.
Most people who experience transverse myelitis will achieve some degree of recovery over time. While the most progress tends to happen within three months of the initial episode, recovery can take longer, sometimes even a year or more. The degree of your recovery tends to depend on the overall cause of transverse myelitis, speed of treatment, and severity of symptoms. If you have any questions regarding your long-term recovery and care, talk to your doctor. It’s also important to be as thorough as possible during appointments to ensure that you’re receiving the proper care.
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