Transverse myelitis

About

Transverse myelitis is an inflammatory disorder caused by an abnormal response of a person’s immune system. It attacks the spinal cord, which is responsible for carrying signals between the brain and the rest of the body. It causes damage to the cells that make up the myelin sheath, which is a protective layer around nerve cells. Symptoms can include pain and numbness in the trunk and limbs, muscle weakness and paralysis, bladder and bowel dysfunction, and difficulty breathing. Treatment depends on the underlying cause, but may include physical therapy, medications, supportive care, and surgical interventions.

Symptoms

The symptoms of Transverse Myelitis vary depending on the level of the spinal cord that is affected. Generally, the symptoms include:

Paralysis or weakness of the legs and lower body
Loss of sensation or reduced sensation in the legs, feet, and/or lower body
Loss of or reduced bladder and bowel control
Pain in the back, legs, or both
Loss of sensitivity to hot and cold temperatures
Increased reflexes and spasticity of the legs
Loss of coordination and difficulty with balance
Sexual problems
Fatigue
0. Difficulty with walking and other activities

Causes

The exact cause of transverse myelitis is often unknown, however there are some known causes such as viral infections, autoimmune disorders, and other inflammatory processes. Additionally, transverse myelitis can be secondary to other medical conditions such as multiple sclerosis, systemic lupus erythematosus, sarcoidosis, or Lyme disease. It can also be caused by certain medications or vaccinations, traumatic spinal cord injuries, or radiation exposure. In some cases, the underlying cause of transverse myelitis may never be identified.

Risk factors

The risk factors for Transverse myelitis are:

Age – Transverse myelitis is more common in adults between the ages of 20–50 years old.
Certain health conditions – People with multiple sclerosis, neuromyelitis optica, or Sjögren’s syndrome are more likely to develop Transverse myelitis.
Exposure to certain viruses – Transverse myelitis can be caused by the measles, mumps, and other viruses.
Exposure to certain drugs – Certain antibiotics, immunosuppressants, anticonvulsants, or drugs used to treat cancer can increase the risk of Transverse myelitis.
Recent vaccines – People who have had recent vaccinations may be at an increased risk for Transverse myelitis, though this is rare.

Diagnosis

Transverse myelitis is typically diagnosed through a combination of a physical exam, imaging tests, and laboratory tests. During the physical exam, the doctor will check the patient’s reflexes, muscle tone, and sensation. Imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT) scans can help identify areas of inflammation in the spinal cord. Laboratory tests such as a complete blood count (CBC) and a type of blood test known as a erythrocyte sedimentation rate (ESR) may be done to see if the patient has an infection or an autoimmune disorder that is causing the inflammation. Finally, a spinal tap or lumbar puncture may be done to collect a sample of cerebrospinal fluid to look for signs of infection or inflammation.

Sub-types

Transverse myelitis is a neurological disorder that affects the spinal cord and can result in inflammation of the entire width of the spinal cord. The condition can be classified into various subtypes which are determined by the cause and presentation of symptoms.

Post-Viral Transverse Myelitis: This is the most common type and is caused by a viral infection. It usually begins with flu-like symptoms and can progress to neurological symptoms such as paralysis, sensory disturbances, and bladder and bowel dysfunction.
Acute Disseminated Encephalomyelitis (ADEM): This is an autoimmune disorder which is caused by the body’s own immune system attacking its own nervous system. It is characterized by sudden onset of neurological symptoms such as confusion, difficulty speaking, lethargy, and paralysis. The symptoms are typically more severe than post-viral transverse myelitis and may last for weeks to months.
Neurosarcoidosis: This is a rare type of transverse myelitis caused by the spread of a type of leukemia called sarcoidosis. Symptoms tend to be similar to post-viral transverse myelitis but can also include abnormal nerve signals, muscle weakness, and optic nerve inflammation.
Neuromyelitis Optica (NMO): NMO is an autoimmune disorder characterized by inflammation of the brain, spine, and optic nerves. Symptoms typically include vision loss, paralysis, and urinary problems.
Devic’s Disease: This is a rare form of transverse myelitis caused by an autoimmune disorder that causes recurrent episodes of inflammation, as well as other neurological symptoms.
Idiopathic Transverse Myelitis: This is the most difficult to diagnose, as it is caused by an unknown factor. Symptoms are typically similar to the other types of transverse myelitis, such as paralysis and sensory disturbances.

Treatments

The treatment options for Transverse myelitis depend on individual patient factors such as cause, age, and severity of symptoms. Common treatments may include:

Corticosteroids: To reduce inflammation and stabilize or reduce symptoms.
Immunomodulatory therapy: To help regulate the immune system and reduce inflammation.
Physical and occupational therapy: To help redevelop muscle strength and dexterity and retrain the brain to use areas temporarily affected by the transverse myelitis.
Plasmapheresis: To remove immune system proteins that may be attacking nerve tissue.
Intravenous Immunoglobulin (IVIg): To provide patients with healthy replacement antibodies to help modify their own faulty immune response.
Rehabilitation: To help patient regain physical, mental and emotional functions lost due to the transverse myelitis.
Medication: To manage other symptoms associated with transverse myelitis such as pain and spasticity.

Prevention

Transverse myelitis is a rare disease, so unfortunately, there is not much that can be done to reduce the risk of developing it. However, there are a few lifestyle changes that may help reduce the risk.

First and foremost, it is important to keep up with any recommended immunizations and vaccinations to reduce the risk of contracting any infectious or contagious illnesses. Keeping up with good hygiene is also important, as well as avoiding smoking, drinking alcohol in excess, and exposing yourself to toxic chemicals and environments.

It is also important to practice good sleep hygiene, managing stress levels, and exercising regularly. Eating a healthy, balanced diet may also help to reduce the risk of transverse myelitis and other illnesses.

Finally, if you think you may be at an increased risk of transverse myelitis or already have it, it is important to discuss this with your healthcare provider to receive appropriate care and treatment.

Gender differences?

There are no gender-specific differences in the presentation or management of Transverse myelitis. However, gender differences may have an influence on the risk factors or duration of the disease. For example, some research suggests that women may have a slightly higher risk of developing transverse myelitis than men, and women may have a longer average duration of the disease. Additionally, women may experience a higher degree of pain during the course of their illness than men.

Nutrition

Nutrition plays an important role in the management of Transverse Myelitis (TM), which is a neurological disorder that affects the spinal cord and can cause motor, sensory and autonomic dysfunction. Nutrition can help to maintain adequate energy in order to support the activities of daily living, as well as support overall healing and recovery. In addition, nutrition can help to reduce inflammation and improve the functioning of the immune system. Eating a balanced diet that is high in fruits, vegetables, and lean proteins, as well as avoiding processed foods, can help to reduce inflammation, support the immune system and provide the necessary nutrients for healing. Additionally, adequate hydration is essential for overall health, and can help to improve the quality of life for those living with TM.

Physical Activity

Physical activity can have a positive impact on people with transverse myelitis due to the various physical and mental benefits associated with regular exercise. Exercise can help improve mobility, strength, flexibility, balance, and circulation. It can also help reduce the risk of cardiovascular disease, obesity, and diabetes, which are all potential complications of transverse myelitis. It’s important to consult with a physician before beginning any exercise regimen, as certain activities may be too aggressive for individuals with transverse myelitis. For optimal benefit, a combination of low-impact aerobic exercise, stretching, and strength training is recommended.