From the Research
Transverse myelitis is a noncompressive myelopathy of inflammatory origin that can cause devastating neurologic effects, with up to two-thirds of patients having a moderate to severe degree of residual disability, as noted in a study published in 2013 1.
Definition and Causes
Transverse myelitis is characterized by inflammation of the spinal cord that damages myelin, the protective coating around nerve fibers, typically affecting a segment of the spinal cord across its entire width, disrupting communication between nerve fibers in the spinal cord and the rest of the body. The causes are broad, ranging from infective or toxic to immuno-mediated etiology, and can be manifestations of systemic diseases, such as sarcoidosis and systemic lupus erythematous, or phenotypes of neuroinflammation, as discussed in a recent study published in 2023 2.
Symptoms and Diagnosis
Symptoms usually develop rapidly over hours to days and may include:
- Weakness in the arms or legs
- Sensory abnormalities (numbness, tingling, or pain)
- Bladder or bowel dysfunction The clinical presentation of transverse myelitis depends on the level of spinal cord damage, and spinal cord magnetic resonance imaging and cerebrospinal fluid examination are the main diagnostic tools, as noted in a study published in 2023 2.
Treatment and Management
Treatment typically involves high-dose corticosteroids like methylprednisolone (1000 mg IV daily for 3-5 days) to reduce inflammation, followed by oral prednisone taper, as discussed in a study published in 1995 3. Plasma exchange therapy may be used for patients who don't respond to steroids, and rehabilitation therapy is crucial for recovery. Some patients may require medications for neuropathic pain such as gabapentin or pregabalin. Management and outcomes depend on the underlying cause, with different probabilities of relapse according to the phenotypes, and immunosuppression is often recommended for the immune-mediated diseases that may have a higher risk of recurrence, as noted in a study published in 2023 2.
Recovery and Outcomes
Recovery varies widely among individuals, with some experiencing complete recovery while others may have permanent disabilities requiring long-term management strategies. The age of onset of the disorder can impact the symptoms and outcomes of affected patients, with differences in manifestation and prognosis between children and adults, as discussed in a study published in 2023 2.