What is transverse myelitis?

Transverse myelitis (TM) is a neurological disorder caused by inflammation of the spinal cord. Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. This causes scars that interrupt communication between the nerves in the spinal cord and the rest of the body.

Symptoms of TM include a loss of spinal cord function over several hours to several weeks.

What usually begins as a sudden onset of lower back pain, muscle weakness, or abnormal sensations in the toes and feet, can rapidly progress to more severe symptoms, including paralysis.

Demyelination (loss of nerve fiber conductivity) usually occurs at the thoracic level, causing problems with leg movement and bowel and bladder control.

Some people recover from TM with minor or no lasting problems, while others have permanent impairments that affect their ability to perform ordinary tasks of daily living.

Transverse myelitis occurs in adults and children, in men and women, and in all races. No familial predisposition is apparent.

The peak number of new cases per year appears to occur in people between ten and 19 years and 30 and 39 years of age.

About 1,400 new cases of transverse myelitis are diagnosed annually in the United States, and approximately 33,000 Americans have some type of disability resulting from TM.

Causes of transverse myelitis

The exact causes of transverse myelitis are not known. The inflammation that damages the spinal cord may result from viral infections, abnormal immune reactions, or insufficient blood flow through the blood vessels located in the spinal cord.

Transverse myelitis may also occur as a complication of syphilis, measles, Lyme disease, and some vaccinations, including those for chickenpox and rabies.

Transverse myelitis often develops following viral infections due to varicella zoster (the virus that causes chickenpox and shingles), herpes simplex, Epstein-Barr, influenza, human immunodeficiency virus (HIV), hepatitis A, or rubella.

Bacterial skin infections, middle-ear infections, and bacterial pneumonia have also been linked with TM.

Some experts believe that infection causes a derangement of the immune system, which leads to an indirect autoimmune attack on the spinal cord. The immune system, which normally protects the body from foreign organisms, mistakenly attacks the body’s own tissue, which causes inflammation and, in some cases, damage to the spinal cord myelin.

Symptoms

Transverse myelitis usually includes the following symptoms:

  • Weakness of the legs and arms
  • Pain
  • Sensory alteration
  • Bowel and bladder dysfunction

Most patients will experience weakness of varying degrees in their legs; some also experience it in their arms.

Pain is the primary symptom of transverse myelitis in about half of all patients. The pain may be localized in the lower back or may consist of sharp sensations that shoot down the legs or arms or around the torso.

Most people with transverse myelitis report heightened sensitivity to heat, cold, or touch; for some a light touch with a finger may cause significant pain (called allodynia).

Treatment and recovery

As with many disorders of the spinal cord, no effective cure exists for people with transverse myelitis. The best medicine has to offer is symptom management.

Therapy generally begins when the patient first experiences symptoms. Physicians may prescribe steroids during the first few weeks of illness to decrease inflammation.

The goal is to keep the body functioning, hoping for complete or partial spontaneous recovery of the nervous system. Some who don’t respond to steroids may undergo plasma exchange therapy (plasmapheresis). This involves replacing plasma, thus removing antibodies that may be involved in inflammation.

People with acute symptoms, such as paralysis, are most often treated in a hospital or in a rehabilitation facility under the care of a specialized medical team. Later, if patients begin to recover limb control, physical therapy is then integrated to help improve muscle strength, coordination, and range of motion begins.

Recovery from transverse myelitis usually begins within two to 12 weeks of the onset of symptoms and may continue for up to two years. However, if there is no improvement within several months, significant recovery is unlikely.

About one-third of people affected with TM experience good or full recovery. Another one-third show fair recovery and are left with deficits such as spastic gait, sensory dysfunction, and urinary urgency or incontinence. The remaining one-third show no recovery, using wheelchairs, perhaps with dependence on others for basic functions of daily living.

Research

The National Institute of Neurological Disorders and Stroke (NINDS) supports research to clarify the role of the immune system in TM and other autoimmune diseases or disorders.

Other work focuses on strategies to repair demyelinated spinal cords, including approaches using cell transplantation. The ultimate goals of these studies are to encourage regeneration and to restore function to patients dealing with paralysis.

Resources and support services

If you are looking for more information on transverse myelitis or have a specific question, our information specialists are available business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9am to 5pm ET.

Additionally, the Reeve Foundation maintains a transverse myelitis fact sheet with additional resources from trusted Reeve Foundation sources. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.

We encourage you to reach out to transverse myelitis support groups and organizations, including:

  • Transverse Myelitis Association (TMA) features news and information for the TM community; facilitates support and networking.
  • Johns Hopkins Hospital Department of Neurology has established a specialized center in Baltimore to care for people with transverse myelitis. The center has gathered physicians and healthcare experts in a variety of disciplines, including neurology, urology, rheumatology, orthopedic surgery, neuroradiology, rehabilitation medicine, and physical and occupational therapy.
  • The Cody Unser First Step Foundation raises research funds to fight paralysis and to build awareness of transverse myelitis and living actively.

This project was supported, in part by grant number 90PR3002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.