From the Research
Transverse myelitis should be diagnosed and treated promptly with high-dose intravenous corticosteroids, usually methylprednisolone 1000mg daily for 3-5 days, to reduce inflammation and prevent further damage, as supported by the most recent and highest quality study available 1.
Diagnosis
Diagnosis of transverse myelitis typically requires evidence of inflammation across both sides of the spinal cord, causing motor, sensory, and autonomic dysfunction. This can be achieved through a combination of:
- Clinical evaluation
- MRI imaging
- Cerebrospinal fluid analysis
- Blood tests to rule out other conditions As noted in 2, transverse myelitis is an acute inflammatory disease of the spinal cord, characterized by rapid onset of bilateral neurological symptoms.
Treatment
Treatment of transverse myelitis should begin with high-dose intravenous corticosteroids, usually methylprednisolone 1000mg daily for 3-5 days, to reduce inflammation and prevent further damage.
- If symptoms don't improve with steroids, plasma exchange therapy (5-7 exchanges over 10-14 days) may be used, as suggested by 1.
- For patients who don't respond to either treatment, intravenous immunoglobulin (IVIG) at 2g/kg divided over 2-5 days might be considered. Rehabilitation is crucial and includes:
- Physical therapy to improve strength and mobility
- Occupational therapy for daily activities
- Bladder management Pain management often involves:
- Gabapentin (300-1200mg three times daily)
- Pregabalin (75-300mg twice daily)
- Amitriptyline (10-75mg at bedtime) Long-term immunosuppressive medications like mycophenolate mofetil or azathioprine may be prescribed if transverse myelitis is part of a recurrent condition like multiple sclerosis or neuromyelitis optica, as mentioned in 3.
Recovery and Outcome
Recovery varies significantly between patients, with some experiencing complete recovery within weeks to months, while others may have permanent disabilities requiring ongoing care and support. As noted in 4, up to two-thirds of patients having a moderate to severe degree of residual disability. It is essential to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions, and to consider the potential benefits and risks of each treatment option, as discussed in 5.