Transverse myelitis is a neurological disorder of the spine caused by inflammation across the spinal cord. It is sometimes associated with the term myelopathy, which refers to any disorder of the spinal cord. However, transverse myelitis is a more specific term for inflammation (myelitis) across the width of the spinal cord (transverse) that results in changed function below this level while function remains normal above. Symptoms are related to movement and sensory functions. This disorder occurs in both adults and children, and typically begins with a rather rapid development of symptoms over the course of several hours, days, or weeks. Symptoms may include lower back pain, weakness in the legs and arms, sensory disturbance, spasms leading to gradual paralysis, and bowel or bladder disfunction.
In most cases, this is a disorder that occurs on a single occasion, although a small number of individuals may experience recurrence. The initial occurrence may be followed, over a period of several weeks or months, by a period of recovery, although this does not happen in all cases. There is considerable variability in the degree of recovery achieved. Transverse myelitis is sometimes associated with other diseases, including systemic autoimmune diseases like systemic lupus erythematosis and sarcoidosis. It may be occur following viral or bacterial infections, especially those associated with a rash, spinal cord injuries, or immune reactions.
Symptoms are related to the specific area within the spinal cord where the inflammation occurs. In general, they may include pain (often in the lower back), weakness of the legs (and, sometimes, arms), loss of sensation below the affected area, and bowel or bladder dysfunction. Symptoms may also include headache, loss of appetite, and numbness or tingling of legs.
Eventually, loss of sensation may be severe, associated with sensorimotor paralysis below the level of the lesion, urinary retention, and loss of sexual function and/or bowel (sphincter) control. Affected individuals may experience thick, rough, dry skin below the spinal lesion, and tendon reflexes may be lost.
The affected individual may notice that his or her legs seem heavier than usual, or that he or she stumbles or drags one foot. Coordination of hand and arm movements may be affected. Over time, progression of the disease may lead to full paralysis of the legs, requiring the patient to use a wheelchair.
Following the initial development of the disease, there may be a period of recovery, although this does not occur in all cases. The improvement, which may occur within the first one to three months, can range from slight to good. Individuals who do not show signs of improvement within the first three months may be more likely to experience long-term deficients from the disease.
Although the exact causes of transverse myelitis are not fully understood, the inflammation that causes damage to nerve fibers of the spinal cord can be caused by viral infections, spinal cord injuries, immune reactions, or insufficient blood flow through the blood vessels in the spinal cord. It can occur as a complication of loss of nerve sheath tissue (demyelination), particularly in optic neuromyelitis or multiple sclerosis. It can also be a complication of reactions to some vaccinations, including those for smallpox, measles, or chickenpox.
Transverse myelitis can be associated with other diseases including acute disseminated encephalomyelitis (ADEM), which is a serious inflammation of the brain and spinal cord. It may be associated with many different diseases, including chickenpox, measles, rabies, smallpox, Lyme disease, Sjogren syndrome, syphilis, and multiple sclerosis.
Transverse myelitis can begin at any time of life. It affects both children and adults. It seems to occur equally among females and males, and among persons of all ethnicities. There does not appear to be a genetic component to the disorder since no familial predisposition has been noted.
There appear to be two age groups in which the largest number of new cases occurs. These peaks are between ages 10 and 19 and between ages 30 and 39. The National Institute of Neurological Disorders and Stroke (NINDS) suggests that there are about 1,400 new cases of transverse myelitis in the USA per year and that 33,000 persons in the USA have some form of disability as a result of transverse myelitis.
Symptoms of the following disorders can be similar to those of transverse myelitis. Comparisons may be useful for a differential diagnosis:
Guillain-Barre syndrome is a very rare, rapidly progressive disorder that consists of inflammation of the nerves (polyneuritis) and, usually, muscle weakness, often progressing to paralysis. Although its precise cause is unknown, a viral or respiratory infection precedes the onset of the syndrome in about half of the cases. This has led to the theory that Guillain Barre syndrome may be an autoimmune disease (a disease that occurs when an abnormal immune system response is triggered). Damage to the covering of nerve cells (myelin) and nerve axons (the extension of the nerve cell that conducts impulses away from the nerve cell body) results in delayed nerve signal transmission. There is a corresponding weakness in the muscles that are supplied or innervated by the damaged nerves.
There is currently no effective cure for people with transverse myelitis. Treatment is symptomatic and supportive. During the first few weeks of the illness, corticosteroid drugs may help in treating spinal cord inflammation. Corticosteroid medications that might be prescribed include methylprednisone and dexamethasone. Pain medications and bedrest may also be helpful during the early weeks of the illness. People with disability that continues after the period of initial illness may benefit from physical therapy to improve muscle strength, coordination, and range of motion.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
For information about clinical trials sponsored by private sources, contact: www.centerwatch.com
The National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) conducts research at the NIH Clinical Center in Bethesda and supports research at other locations on spinal cord disorders and demyelinating diseases (ones in which the lining of nerve tissues is damaged) such as transverse myelitis. NINDS researchers are seeking to clarify the role of the immune system in the initiation of autoimmune diseases, to develop strategies to repair spinal cords in which the myelin lining has been damaged, and to develop electrical and mechanical devices to help individuals with spinal cord damage compensate for lost function.
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REVIEW ARTICLES Chen HC, Lai JH, Juan CJ, et al. Longitudinal myelitis as an initial manifestation of systemic lupus erythematosus. Am J Med Sci. 2004;327:105-08.
Andronikou S, Albuquerque-Jonathan G, Wilmhurst J, et al. MRI findings in acute idiopathic transverse myelopathy in children. Pediatr Radiol. 2003;33:624-29.
Boos J, Davis LE. Smallpox and smallpox vaccination: neurological implications. Neurology. 2003;60:1241-45.
Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59:499-505.
Sherer Y, Hassin S, Shoenfeld Y, et al. Transverse myelitis in patients with antiphospholipid antibodies—the importance of early diagnosis and treatment. Clin Rheumatol. 2002;21:207-10.
JOURNAL ARTICLES Ghezzi A, Bergamaschi R, Martinelli V, et al. Clinical characteristics, course and prognosis of relapsing Devic's Neuromyelitis Optica. J Neurol. 2004;251:47-52.
Krishnan C, Kaplin AI, Deshpande DM, et al. Transverse Myelitis: pathogenesis, diagnosis and treatment. Front Biosci. 2004;9:1483-99.
D'Cruz DP, Mellor-Pita S, Joven B, et al. Transverse myelitis as the first manifestation of systemic lupus erythematosus. Am J Med Sci. 2004;31:280-85.
Torabi AM, Patel RK, Wolfe GI, et al. Transverse myelitis in systemic sclerosis. Arch Neurol. 2004;61:126-28.
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Miyazawa R, Ikeuchi Y, Tomomasa T, et al. Determinants of prognosis of acute transverse myelitis in children. Pediatr Int. 2003;45:512-16.
Kim KK. Idiopathic recurrent transverse myelitis. Arch Neurol. 2003;60:1290-94.
Defresne P, Hollenberg H, Husson B, et al. Acute transverse myelitis in children: clinical course and prognostic factors. J Child Neurol. 2003;18:401-06.
Oleson CV, Sivalingham JJ, O'Neill BJ, et al. Transverse myelitis secondary to coexistent Lyme disease and babesiosis. J Spinal Cord Med. 2003;26:168-71.
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FROM THE INTERNET Transverse Myelitis Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). Reviewed September 16, 2002. www.ninds.nih.gov/health_and_medical/pubs/transverse_myelitis.htm
Transverse Myelitis Association 1787 Sutter Parkway Powell, OH 43065-8806 USA Tel: (614)766-1806 Email: ssiegel@myelitis.org Internet: http://www.myelitis.org
Spinal Cord Society 19051 County Hwy. 1 Fergus Falls, MN 56537 USA Tel: (218)739-5252 Fax: (218)739-5262 Email: scs-nc@nc.rr.com Internet: http://www.spinalcordsociety.com
American Paraplegia Society 75-20 Astoria Boulevard Jackson Heights, NY 11370-1177 USA Tel: (718)803-3782 Fax: (718)803-0414 Email: aps@UnitedSpinal.ORG Internet: http://www.apssci.org
National Spinal Cord Injury Association 6701 Democracy Suite 300-9 Bethesda, MD 20817 USA Tel: (301)214-4006 Fax: (301)881-9817 Tel: (800)962-9629 Email: info@spinalcord.org Internet: http://www.spinalcord.org
National Institute of Neurological Disorders and Stroke (NINDS) 31 Center Drive 8A07 Bethesda, MD 20892-2540 Tel: (301)496-5751 Fax: (301)402-2186 Tel: (800)352-9424 Email: braininfo@ninds.nih.gov Internet: http://www.ninds.nih.gov/
MUMS (Mothers United for Moral Support, Inc) National Parent-to-Parent Network 150 Custer Court Green Bay, WI 54301-1243 USA Tel: (920)336-5333 Fax: (920)339-0995 Tel: (877)336-5333 Email: mums@netnet.net Internet: http://www.netnet.net/mums/
Christopher Reeve Paralysis Foundation 500 Morris Ave Springfield, NJ 07081 USA Tel: (973)379-2690 Fax: (973)912-9433 Tel: (800)225-0292 Email: info@crof.org Internet: http://www.crpf.org, http://www.paralysis.org
Genetic and Rare Diseases (GARD) Information Center PO Box 8126 Gaithersburg, MD 20898-8126 Tel: (301)519-3194 Fax: (240)632-9164 Tel: (888)205-2311 TDD: (888)205-3223 Email: gardinfo@nih.gov Internet: http://www.genome.gov/10000409
Devic's Support 107 Woodside Manor Carmichaels, PA 15320 Email: gmitchell@myelitis.org or grace53a@gmail.com Internet: http://groups.google.com/group/Devics-support?pli=1
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