Transverse myelitis is a neurologic syndrome associated with damage to nerve cells in the spinal cord. In many cases, treatment with cortisone results in almost complete rehabilitation.
What is transverse myelitis?
Transverse myelitis (TM) is a neurological disorder associated with inflammation of the spinal cord. Here, “myelitis” stands for inflammation of the spinal cord, and “transverse” refers to the fact that the entire cross-section of the spinal cord segment in question is affected. The inflammatory processes in the spinal cord damage nerve cells by attacking the myelin sheath around the nerve fiber. Myelin plays an important role in the central nervous system in the transmission of electrical signals. In transverse myelitis, the speed of transmission is significantly reduced. TM is a relatively rare disease. Statistically, males and females are affected with equal frequency. Adolescents between the ages of ten and nineteen and adults between the ages of 30 and 49, respectively, have the highest risk of developing TM.
Causes
In idiopathic transverse myelitis, the cause is unknown. It is likely to be an autoimmune disease. This involves an overreaction of the immune system in which healthy tissue is permanently damaged. Multiple sclerosis (MS) is an autoimmune disease in which the myelin sheath of nerve cells in the brain is destroyed. Transverse myelitis could have a similar disease process, but in which the nerve cells of the spinal cord are damaged. Occasionally, the disease occurs in conjunction with another condition. TM may develop as a result of an infection, for example. Infection with pathogens such as the HIV virus, Epstein-Barr virus, herpes zoster, or the rabies pathogen rarely causes transverse myelitis. Bacterial diseases such as tuberculosis, Lyme disease or syphilis are also suspected of causing TM. In addition, this neurological disease occurs in rare cases together with autoimmune diseases such as sarcoidosis or MS. Furthermore, TM may be due to thrombosis of the spinal arteries. The spinal arteries are responsible for supplying blood to the spinal cord.
Symptoms, complaints, and signs
The symptoms of TM depend greatly on the affected area of the spinal cord. Initial symptoms appear within hours to weeks after the onset of the disease. In about half of those affected, inflammation peaks within the first day. Complaints arise because there are motor neurons in the spinal column that can no longer do their job adequately. The exchange of information between the body periphery such as the extremities and the brain is disturbed. Affected persons suffer from sensory disturbances and back pain. In severe courses, functional disorders of the urinary bladder and rectum occur. The first sign of transverse myelitis is usually an increasing feeling of weakness in the legs. Occasionally, weakness may also occur in the arms. There is a loss of sensation below the affected spinal cord segment. A feeling of numbness in the area of the legs and trunk as well as a reduced sensitivity to pain are typical symptoms of TM. Temperature perception is also largely altered. Sexual dysfunction is frequently observed in connection with this disease. In severe forms, muscle weakness develops into paraplegia or spastic paralysis. In addition, patients suffer from mood swings, are exhausted, and are prone to depressive moods.
Diagnosis and course of the disease
At the beginning of the diagnosis, the treating physician takes a detailed medical history. Characteristic symptoms such as insensitivity to pain in the legs can be tested, for example, by the patient’s reaction to a pinprick. After the initial tentative diagnosis, an MRI and an examination of the spinal fluid are usually performed. The course of the disease depends greatly on the circumstances of the individual case. If treatment is given in time, most patients recover completely. However, recovery is lengthy and can take months to years. It is possible that some symptoms, such as a slight tingling sensation in the legs, may persist even after the inflammation has healed.
Complications
If transverse myelitis remains untreated for a prolonged period, secondary symptoms and sometimes serious complications may develop. Due to the impaired exchange of information, sensory disturbances and back pain are initially noticeable. A severe course results in functional disorders of the urinary bladder and rectum. This is accompanied by a feeling of weakness in the legs, which becomes stronger as the disease progresses and eventually causes serious movement disorders. In individual cases, this symptom also occurs in the arms. Due to the reduced sensitivity to pain that occurs in advanced TM, there is an increased risk of injury, as the affected person no longer perceives burns and hypothermia correctly, for example. A negative progression can cause spastic paralysis and even paraplegia. Psychological complaints are also possible: mood swings, depressive mood and chronic exhaustion, for example. In the treatment of transverse myelitis, side effects from prescribed antibiotics and antivirals are possible. Plasmapheresis carries the risk of infections and blood clotting disorders. In single cases, injuries may also occur at the site of the puncture or the patient may have an allergic reaction to the agents and materials used.
When should you go to the doctor?
Consultation with a physician should be sought in the event of a feeling of illness, malaise, or a decrease in physical performance. An elevated body temperature, irritability, as well as an inner restlessness indicate a present disease. Sensitivity disorders on the skin, irregularities in the perception of touch as well as a loss of muscle strength are signs of a disease. Medical examinations are necessary to clarify the cause. Changes in heart rhythm, functional disorders, as well as irregularities of the digestive tract should be presented to a physician. Characteristic of the disease in a severe course are abnormalities in the activity of the urinary bladder. Therefore, in these cases, consultation with a physician should be sought immediately. If there are restrictions of movement, exhaustion, mood swings or signs of paralysis, a doctor is also needed. The affected person needs medical care so that there is relief from the symptoms. Furthermore, a visit to the doctor should be initiated if behavioral abnormalities become apparent. Depressive moods, aggressive tendencies, as well as a severe decrease in well-being should be presented to a physician. The physical irregularities are often concentrated in the area of the spine. If there are different temperature perceptions, numbness or sensitivity to pain, there is cause for concern and a need for action. To avoid complications or secondary diseases, a doctor should be consulted immediately.
Treatment and therapy
Therapy should be given as soon as possible to prevent permanent damage to the nerves of the spine. The administration of medications containing cortisone helps to dampen the excessive immune response and counteract the inflammation. If a bacterial or viral infection is present, antibiotics or antivirals, respectively, are administered. In some cases, plasmapheresis is promising as part of acute therapy. This is a procedure in which antibodies are selectively filtered from the blood. In transverse myelitis, those antibodies are removed that attack the myelin layer of the nerve fibers in the spinal cord. However, this treatment is only applicable in special cases. After successful acute therapy follows the phase of rehabilitation, in which the original physical fitness should be restored. Disturbances in coordination, paralysis and muscle weakness are treated with physiotherapy. Heat applications and massages help with pain and movement restrictions. In order to maintain the successes achieved in the long term, self-training at home is important. Depending on the severity of the disease, drug therapy may also be necessary after acute therapy and rehabilitation. This depends on the individual needs of the patient. It is not uncommon for pain medication to continue to be necessary.
Prevention
Targeted prevention is not possible. Late effects of bacterial or viral infections can largely be prevented if a physician is consulted in time.In addition, it is important to complete initiated therapies as prescribed and not to discontinue treatment prematurely. In case of neurological deficits such as numbness, a specialist should be consulted immediately. In this way, the prognosis of transverse myelitis improves in many cases.
Follow-up
In transverse myelitis, aftercare is primarily concerned with physical rehabilitation. In this phase, the organism receives gentle support to restore its health status. According to the doctor’s recommendation, the patients should improve their coordination again and overcome the muscle weaknesses. For this purpose, targeted physiotherapy takes place. Massages and heat applications help against the pain and restrictions caused by the disease. The subsequent self-training following this therapy ensures long-term success and strengthens the body. In some cases, medication may be necessary to reduce the pain. Long-term rehabilitation plays a major role in the aftercare phase. Its purpose is to reverse the functional limitations. In connection with neurological recovery, it is also important to combat psychological problems such as anxiety and depressive moods. Often, those affected feel limited in their performance and their self-confidence decreases. Intensive psychotherapy counteracts such complexes and increases self-esteem. To monitor the improvement in health, doctors recommend keeping a complaints diary. This is not only suitable for recording symptoms such as numbness, which can indicate late effects. Patients should also keep a detailed record of the medications they take.
Here’s what you can do yourself
Transverse myelitis requires medical treatment. The most important self-help measure is to keep a diary of symptoms and otherwise follow the doctor’s instructions regarding the use of medications. If complications occur, a visit to the doctor is recommended. Transverse myelitis requires intensive rehabilitation. Important adjunctive measures include physical therapy and physical treatments. Patients can perform heat applications and baths at home to inhibit pain and functional limitations. During neurological rehabilitation, anxiety and depression should be avoided. Affected people often feel low performance and subsequently develop emotional symptoms. Therapeutic treatment can improve self-esteem. The therapy also includes massages, rod baths and various activation and relaxation treatments. These include water massages, Mediwave or treatment using bass vibrations. Self-training is essential for treatment success. Patients are best advised to talk to their specialist and have an individual therapy program put together, which they can carry out at home without medical support. The association Myelitis e. V. can name further measures and means and provide patients with contact points for treatment and accompanying therapy.
