Transverse Myelitis

Transverse myelitis is a disease caused by inflammation of the spinal cord. It is characterized by the symptoms and signs of neurological dysfunction in the sensory and motor pathways on both sides of the spinal cord. Involvement of sensory and motor control pathways often causes sensory changes, weakness, and sometimes intestinal or urinary dysfunction.

Symptoms

There are four symptoms which are:

1. sensory symptoms such as tingling or numbness
2. weakness in the arms or legs
3. bowel motility problems and/or bladder dysfunction
4. pain and discomfort

The distribution of these symptoms is symmetrical or asymmetric and affects the arms, legs or both. The term transverse refers to dysfunction at a particular level of the spinal cord. However, this term can be misleading. Not all spinal cords have complete anatomical damage, but local inflammation that can lead to asymmetric dysfunction of the spinal cord below levels affected during functioning. Above this level is normal. Therefore, the term myelitis ism often used.

Causes

60% of TM cases cause remain unknown even though there being the presence of inflammatory mechanisms. However, the remaining 40% are associated with autoimmune diseases such as neuromyelitis optica, multiple sclerosis, Sjogren’s syndrome, systemic lupus erythematosus and sarcoidosis. However, the lack of evidence of the causative disorder, mechanism, or pathogen may be the result of a failed early diagnosis or the immediate disappearance of causative factors such as post-infection illnesses and viral infections.

TM is an unbiased condition that affects all age groups regardless of family history, race or gender. In young patients, TM may be the first sign of a disease such as neuromyelitis optica or multiple sclerosis. In some patients, stroke or spinal cord infarction can be confused with TM, which can lead to the wrong treatment approach.

Diagnosis

Characterizing the clinical profile of patients with suspected TM always requires a very good clinical interview to explain the onset of symptoms and careful neurological examination. Two common tests are used for suspicious symptoms, in addition to clinical evaluation, which are Lumbar puncture and MRI of the spinal cord.

In addition to neuroimaging and CSF testing of the spinal cord, blood / serological testing helps rule out systemic disorders such as rheumatic disorders, metabolic disorders or infections. Although the above two steps facilitate diagnosis, it is important to note that the results do not predict the outcome of patients with transverse myelitis.

Treatment

Intravenous Steroids: There are no clinical studies supporting a unique approach to treating TM patients, but patients with suspected acute myelitis receive high doses of methylprednisolone intravenously for 35 days is generally accepted. The decision to add new treatments is often based after 5 days of steroids and MRI.

Plasma Exchange: It is often used in patients with moderate to aggressive TM who do not show significant improvement after intravenous and oral steroid therapy. Again, although there have been no clinical trials demonstrating the efficacy of Plasma Exchange (PLEX) for TM, retrospective studies of TM patients treated with intravenous steroids followed by PLEX have been positive. PLEX has also been effective in some patients with inflammatory or other autoimmune diseases of the central nervous system.

Other forms of immune-based intervention may be required for patients who do not respond to steroids or PLEX and continue to have active inflammation of the spinal cord. The use of immunosuppressive agents may be required. One of these approaches may include intravenous use of cyclophosphamide, a commonly used chemotherapeutic drug for leukaemia or lymphoma.