Transverse myelitis is an inflammation of the spinal cord. The inflammation interrupts communications between nerve fibers in the spinal cord and the rest of the body, affecting sensation and nerve signaling below the damage to the protective nerve coating called myelin.
The segment of the spinal cord at which the damage occurs determines which parts of the body are affected. Damage at one segment will affect function at that level and below.
In people with transverse myelitis, the myelin damage most often occurs in nerves in the upper back, causing problems with leg movement and bowel and bladder control, which require signals from the lower segments of the spinal cord.
Symptoms may develop suddenly or over days or weeks. Classic symptoms include: weakness of the arms and legs, sensory alterations such as burning, pricking, numbness, or sensory loss, pain (usually in the lower back or down the legs and arms or around the torso), and bowel and bladder dysfunction.
Some cases of transverse myelitis occur on their own, but a number of conditions appear to cause the disorder, including immune system disorders, bacterial and viral infections, fungal infections, and various parasites.
Transverse myelitis can affect people of any age, but a peak in incidence rates appears to occur between 10 and 19 years of age and 30 to 39 years of age.
No effective cure currently exists for people with transverse myelitis. Physicians often prescribe corticosteroid drugs to decrease inflammation and reduce immune system activity.
Plasma exchange therapy may be used for people who don't respond well to intravenous steroid drugs.
Medications may be prescribed to treat pain and other symptoms and complications.
Rehabilitative therapy (physical, occupational, vocational, and psychotherapy) can help individuals become as functionally independent as possible.
Most people with transverse myelitis have at least partial recovery, with most recovery taking place within the first 3 months after the attack. Recovery may continue for up to 2 years (and sometimes longer) in some people.
If there is no improvement within the first 3 to 6 months, complete recovery is unlikely (although some recovery can occur and still requires rehabilitation). Some individuals may have moderate disability while others have permanent weakness and other complications.
Many individuals experience only one episode of transverse myelitis. Some people recover completely and then experience a relapse, while others begin to recover and then suffer worsening of symptoms before recovery continues.
Researchers at the National Institute of Neurological Disorders and Stroke (NINDS) are working to better understand the process by which the immune system destroys or attacks myelin in transverse myelitis and autoimmune disorders.
NINDS-funded scientists are studying cellular mechanisms that control the generation and maturation of cells that generate myelin-producing cells, while other scientists hope to develop a better understanding of the molecular control of myelination.
Additional research funded by NINDS aims to develop new imaging techniques to assess the relationship between spinal cord pathology and neurological dysfunction in multiple sclerosis, which may possibly aid in other myelin disorders such as transverse myelitis. NINDS also funds researchers who are using animal models of spinal cord injury to study strategies for replacement or regeneration of spinal cord nerve cells.
The knowledge gained from such research should lead to a greater knowledge of the mechanisms responsible for transverse myelitis and may ultimately provide a means to prevent and treat this disorder.
