What is Transverse Myelitis (TM)?
Transverse Myelitis (TM) is a neurological disorder caused
by inflammation of a segment of the spinal cord. The term "myelitis"
refers to inflammation of the spinal cord, while "transverse"
indicates that the inflammation extends across the width of the spinal cord.
This inflammation can damage or destroy myelin, the protective covering of
nerve fibers, leading to scarring that disrupts communication between the
spinal cord and the rest of the body.st of the body.
Who is affected?
TM can affect individuals of all ages, genders, and racial
backgrounds. It does not appear to have a genetic or familial predisposition.
The estimated incidence rate of TM is approximately 1.3 cases per 1,000,000
people per year. Research indicates that TM is most commonly diagnosed between
the ages of 10–19 and 30–39.
What are the Symptoms of TM?
Symptoms of TM typically develop rapidly over hours to
several days, though in some cases, they may progress more gradually over
weeks. Most cases affect both sides of the body, but some experience
asymmetrical symptoms.
Common symptoms include:
·
Pain: Initial symptoms often
include lower back pain and abnormal sensations (paresthesias) such as
tingling, burning, pricking, or numbness in the legs.
·
Muscle weakness and paralysis:
Weakness in the legs (paraparesis) can progress to full paralysis (paraplegia)
of the lower body.
·
Sensory disturbances: Patients
may feel numbness, heightened sensitivity to touch (allodynia), or extreme
sensitivity to temperature changes.
·
Bladder and bowel dysfunction:
Symptoms may include urinary urgency, incontinence, difficulty urinating, or
constipation.
·
Other symptoms: Some
individuals experience muscle spasms, fever, headache, loss of appetite, or, in
severe cases, breathing difficulties if the inflammation affects the upper
spinal cord.
Prognosis of TM
Recovery from TM varies significantly:
· About
one-third of patients recover with little or no lasting disability.
· Another
one-third retain some neurological impairments, such as muscle weakness and
bladder issues.
· The remaining
one-third experience severe disability, including paralysis and incontinence.
Most individuals with TM experience only a single episode,
but some may have relapses. In these cases, doctors investigate underlying
conditions such as multiple sclerosis (MS) or systemic autoimmune disorders.
Diagnosis
Diagnosis of TM requires a comprehensive neurological
examination, imaging tests, and laboratory studies:
·
MRI scans help detect
inflammation in the spinal cord and rule out conditions such as MS, stroke, or
tumors.
·
Lumbar puncture (spinal tap) is
used to analyze cerebrospinal fluid (CSF) for signs of infection or autoimmune
activity.
·
Blood tests may be performed to
check for infections, vitamin deficiencies, or autoimmune disorders.
Causes of TM
The exact cause of TM is not always clear. Possible
triggers include:
·
Viral infections (e.g., herpes
simplex, Epstein-Barr, enteroviruses, and COVID-19)
·
Autoimmune
diseases
(e.g., multiple sclerosis, lupus, Sjögren’s syndrome, sarcoidosis)
·
Post-vaccination responses
(though rare, TM has been linked to some vaccines, including those for rabies
and COVID-19)
·
Vascular issues (e.g., reduced
blood flow or blood vessel abnormalities in the spinal cord)
·
Cancer-related immune responses
(paraneoplastic syndromes)
Some cases of TM remain
idiopathic, meaning no clear cause is identified.
Treatment for TM
Currently, there is no cure for TM, but treatments focus on
managing symptoms and reducing inflammation:
·
High-dose corticosteroids
(e.g., methylprednisolone) are the first-line treatment to reduce spinal cord
inflammation.
·
Plasma exchange therapy (plasmapheresis) may be used for patients who do not respond to steroids.
·
Pain management with
medications such as antidepressants, anticonvulsants, and muscle relaxants.
·
Immunosuppressive therapies
(e.g., azathioprine, mycophenolate, cyclophosphamide) may be used in recurrent
cases or when an autoimmune cause is suspected.
·
Physical therapy and rehabilitation are essential for regaining mobility and improving daily function.
Patients with TM often require long-term medical care,
including support for bladder and bowel function, mobility assistance, and
psychological support. Research continues to explore new treatments and the
underlying mechanisms of TM.