Transverse myelitis(TM) is a neurologic syndrome of spine that is caused by inflammation across the spinal cord. Inflammation is usually a protective response, which generally includes swelling, pain, heat and redness, however in case of transverse myelitis, the inflammatory response causes damage to the spinal cord, resulting in varying degree of weakness and sensory symptoms. The symptoms and dysfunction that occurs is usually dependent on the level of spine where the inflammation is located.
TM is believed to be linked with immune system. It is possible that the immune system is attacking the body’s own spinal cord. It occurs in both children and adults. Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers the nerve cell fibers. This damage causes nervous system scars that interrupt communication between the nerves in the spinal cord and rest of the body. Typically the higher the spinal cord is affected, the more severe the impairement. Nerves in the cervical(neck)region control signals to the neck, arms, hands and muscles of breathing(diaphragm). Nerves in the thoracic region supplies signal to the torso(foot) and some part of arms. Nerves at lumbar(mid back) control signals to the hip and legs and sacral nerves located within the lower segment of the spinal cord provide signal to the groin, toes and some parts of legs. Damage at one segment will affect function at that segment and segments below it. In patients with transverse myelitis, inflammation occur at thoracic level, causing problem with leg movements and bladder and bowel control, which require signals from the lower segment of the spinal cord.
Causes of transverse myelitis
The inflammation that causes an extensive damage to the nerve fibers of the spinal cord may result from viral infections or abnormal immune reactions. Viral agents include varicella zoster( that causes chicken pox) herpes simplex cytomegalo virus Epstein virus , HIV virus hepatitis A and rubella. Bacterial skin infections, middle ear infections have also been associated with the condition. In auto immune diseases, the immune system which normally protects the body from foreign organisms, mistakenly attack the body’s own tissue, causing inflammation and damage to the myelin within the spinal cord.
Symptoms of transverse myelitis
Transverse myelitis may be either acute (developing over hours to several days) or subacute (usually developing over 1 to 4 weeks). Initial symptoms usually include localized lower back pain, sudden paresthesias (abnormal sensations such as burning, tickling, pricking, or tingling) in the legs, sensory loss, and paraparesis (partial paralysis of the legs). Paraparesis may progress to paraplegia (paralysis of the legs and lower part of the trunk). Urinary bladder and bowel dysfunction is common. Many patients also report experiencing muscle spasms, a general feeling of discomfort, headache, fever, and loss of appetite. Depending on which segment of the spinal cord is involved, some patients may experience respiratory problems as well From this wide array of symptoms, four classic features of transverse myelitis occur: (1) weakness of the legs and arms,
(3) sensory alteration,
(4) bowel and bladder dysfunction.
Most patients will experience weakness of varying degrees in their legs; some also experience it in their arms. Initially, people with transverse myelitis may notice that they are dragging one foot or that their legs seem heavier than normal. Coordination of hand and arm movements, as well as arm and hand strength may also be compromised. Progression of the disease leads to full paralysis of the legs, requiring the patient to use a wheelchair. Pain is the primary presenting symptom of transverse myelitis. The pain may be localized in the lower back or may consist of sharp, shooting sensations that radiate down the legs or arms or around the torso(foot) Patients who experience sensory disturbances often use terms such as numbness, tingling, coldness, or burning to describe their symptoms. Bladder and bowel problems may involve increased frequency of the urge to urinate or have bowel movements, incontinence, difficulty voiding, the sensation of incomplete evacuation, and constipation. Recovery may be absent, partial or complete and generally begins within 1 to 3 months
What tests are conducted to diagnose transverse myelitis
In order to rule out other diseases and disorders, Physicians must conduct a physical examination and a number of additional tests like
- Blood Tests: Used to screen for possible viruses or vitamin deficiencies.
- MRI (magnetic resonance imaging): Provides images of the brain and spinal cord so that lesions can be identified.
- Lumbar Puncture: Provides information about white blood cell count and immune system activity
A lumbar puncture involves removing a small amount of spinal fluid from the spinal cord. The spinal fluid provides information about white blood cell counts. It can also demonstrate any abnormal activity of the immune system.
Treatment of transverse myelitis
Several therapies target the acute signs and symptoms of transverse myelitis:
Steroids help reduce the inflammation in the spinal column.
spinal cord damage include common pain relievers, including acetaminophen , ibuprofen, naproxin; antidepressant drugs and anticonvulsant drugs.
Other therapies focus on long-term recovery and care:
Physical therapy helps to increase strength and improve coordination. physical therapist will likely teach how to use assistive devices, such as a wheelchair, canes or braces, if needed.
This type of therapy helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
A psychotherapist can use talk therapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioural issues that may cause transverse myelitis.
Some individuals living with transverse myelitis have had success with acupuncture. There is no evidence that this therapy works, but it has been deemed successful by some individuals.