What is the Cause of Transverse Myelitis?

Understanding Transverse Myelitis: Causes, Diagnosis & Recovery

Inflammation in the spinal  cord can lead to a rare neurological condition known as transverse myelitis (TM). This disorder often brings on sudden symptoms, including muscle weakness, pain, and issues with bladder function. Various factors can trigger this condition. While some individuals fully recover from TM and its complications, others may experience lasting effects.

Therefore, it is crucial to understand the cause of transverse myelitis for early diagnosis and proper treatment. Keep reading to learn more about this disorder's cause.

What is transverse myelitis (TM)?

Transverse myelitis (TM) results from inflammation within the spinal cord. When inflammation occurs, it damages the myelin sheath, the protective covering surrounding the nerve cells in the spinal cord.

This disruption interferes with the communication between the spinal nerves and the body, leading to problems such as impaired sensation, difficulty with movement, and issues controlling the bladder.

TM can affect any part of the spinal cord, regardless of its location along the spine. The term ‘transverse’ describes the distribution of sensory and functional changes, while ‘myelitis’ refers to inflammation of the spinal cord. Usually, individuals experience a band-like sensation around the torso, with altered sensation below this level.

What are the causes of transverse myelitis?

The exact cause of transverse myelitis remains uncertain. Research shows that it can occur when the immune system mistakenly attacks healthy tissues or reacts excessively while combating illnesses such as viral, bacterial, or fungal infections.

Several factors are associated with the development of TM:

1.  Autoimmune Disorders

It occurs when the immune system malfunctions and wrongly targets the body’s own cells, tissues, and organs. Conditions linked to TM include ankylosing spondylitis, lupus, antiphospholipid syndrome, rheumatoid arthritis, Behçet’s disease, and Sjogren’s syndrome.

2.  Infections

Various infections have been connected to TM, including:

• Bacterial Infections: Lyme disease, tuberculosis, and syphilis.
• Fungal Infections: Blastomyces, Aspergillus, coccidioides, candida, and cryptococcus affecting the spinal cord.
• Parasitic Infections: Toxoplasmosis, cysticercosis, schistosomiasis, and strongyloidiasis.
• Viral Infections: Zika virus, West Nile virus, varicella-zoster (responsible for chickenpox and shingles), and enterovirus.

3.  Multiple Sclerosis (MS)

In rare situations, TM may be an early indicator of multiple sclerosis or may appear during a relapse. In such cases, TM symptoms are often among the initial signs of MS.

4.  Neuromyelitis Optica

It leads to inflammation of the spinal cord and optic nerves. TM caused by neuromyelitis optica often affects both sides of the body and may also produce eye-related symptoms, such as pain during eye movement and temporary vision impairment.

5.  Vaccinations

Though infrequent, some vaccines have been associated with TM. However, these occurrences are rare, and current evidence does not support altering standard vaccination recommendations.

6.  Sarcoidosis

Sarcoidosis, a condition marked by widespread inflammation, can also lead to TM in rare instances. Spinal cord involvement is uncommon, occurring in less than 1% of sarcoidosis cases.

What are the Common Symptoms of Transverse Myelitis?

The signs and symptoms of transverse myelitis often appear over several hours or days, though in some cases, they may develop gradually over weeks. Common signs and symptoms include:

• Pain: Discomfort often starts suddenly in the lower back. Sharp, shooting pain may radiate down the arms or legs or around the chest and abdomen. The nature and location of the pain often depend on which part of the spinal cord is involved.
• Abnormal Sensations: Many individuals experience numbness, tingling, burning, or a sensation of coldness. Some may become highly sensitive to light touch from clothing or extreme temperatures.
• Weakness in the Limbs: Some people experience a feeling of heaviness in their legs or stumble or drag a foot while walking. In more severe cases, significant weakness or complete paralysis may occur.
• Bladder and Bowel Dysfunction: Symptoms can include frequent urination, urinary incontinence, difficulty emptying the bladder, and constipation.

How Do You Treat Acute Transverse Myelitis?

Several treatments focus on managing the immediate symptoms and effects of transverse myelitis, such as:

• Pain Management : Ongoing pain is a frequent issue for those with transverse myelitis. Over-the-counter pain relievers such as ibuprofen, acetaminophen, and naproxen sodium may help alleviate muscle discomfort. Nerve-related pain may be managed with certain antidepressants like tricyclic antidepressants (e.g., amitriptyline) or anticonvulsants (e.g., gabapentin).
• Preventive Medications : Individuals with neuromyelitis optica-associated antibodies may require long-term treatment with corticosteroids and immunosuppressive medications to lower the risk of future transverse myelitis episodes or optic neuritis.
• Intravenous Corticosteroids :Patients typically receive steroids administered through a vein over several days. These medications help reduce inflammation within the spinal cord.
• Plasma Exchange (Plasmapheresis) : For individuals who do not improve with intravenous steroids, plasma exchange may be recommended. This procedure involves removing the plasma and replacing it with substitute fluids.
• Antiviral Drugs : When a viral infection affects the spinal cord, antiviral drugs may be prescribed to treat the root cause of the infection.
• Medications for Other Symptoms : Additional drugs may be prescribed to address muscle stiffness, bladder or bowel dysfunction, depression, and other complications related to transverse myelitis.
• Physical Therapy : It focuses on enhancing strength and coordination. A physical therapist can also provide instruction on using mobility aids like wheelchairs, canes, or braces if necessary.
• Occupational Therapy : Occupational therapists help individuals adapt daily activities, including personal care, cooking, and housekeeping, to accommodate their physical limitations.
• Psychotherapy : Talk therapy may assist in addressing emotional challenges such as anxiety, depression, sexual issues, and other psychological effects of living with transverse myelitis.

Transverse myelitis is a rare but serious condition that affects the spinal cord. It often leads to pain, weakness, abnormal sensations, and bladder or bowel issues.