Dr. Elena Grebenciucova is a former James T. Lubin Fellow. She is currently a neurologist and a faculty member at Northwestern University in Chicago. We asked Dr. Grebenciucova to give us a brief overview on transverse myelitis. For more information on transverse myelitis, click here.
1. What is TM?
Transverse myelitis is a general term used to describe inflammation in the spinal cord. The word transverse means that the inflammation spreads across left and right half of the spinal cord at any particular level. Not all cases of myelitis are transverse; some may involve only a part of the spinal cord. Transverse myelitis (inflammation of the spinal cord) can occur as a result of a variety of inflammatory, infectious and post-infectious immune-mediated disorders and, in some cases, where no inciting factor or an underlying condition is found, TM may be considered idiopathic. Sometimes TM is not idiopathic and can be the initial presentation of conditions that can affect the spinal cord, for example, TM can occur with multiple sclerosis, neuromyelitis optica and ADEM.
2. What are the initial signs and symptoms of TM?
Initial signs and symptoms of transverse myelitis depend on the location of the inflammation. For example, if the inflammatory lesion is located in the cervical spinal cord, the symptoms frequently involve both arms and legs. If the lesion is located in the thoracic spinal cord, the arms are spared, but the legs are affected. Some cases of transverse myelitis are very extensive and affect parts of cervical and thoracic spinal cord. As a rule, people are affected from the spinal cord level where the attack occurred and below. Transverse myelitis can present with a combination of symptoms such as loss of sensation, tingling in one’s hands/arms or legs, pain in the back, loss of strength in one’s arms and/or legs as well as problems controlling one’s bladder and bowels. In fact, many people with TM may experience bowel and bladder symptoms at onset because these functions are partially controlled at the bottom of the spinal cord.
3. How does someone get TM?
There are no known risk factors or behaviors that predispose someone specifically to transverse myelitis. Having a family history of an autoimmune disorder that affects the spinal cord may predispose that individual to the same autoimmune disorder, but it is not a guarantee that they will develop transverse myelitis. For example, patients with multiple sclerosis and systemic lupus erythamatosus can develop inflammatory lesions in the spinal cord, resulting in transverse myelitis; however, not all patients with systemic lupus erythematosus or multiple sclerosis develop transverse myelitis. There is no known genetic predisposition to transverse myelitis at this time.
4. How is TM diagnosed?
Transverse myelitis diagnosis is based on patient’s symptoms, findings on the neurological exam, magnetic resonance imaging and results of the cerebrospinal fluid (obtained via a lumbar puncture). The doctors will take special care to exclude mimics of transverse myelitis such as tumors and blood vessel abnormalities or blood clots that can result in ischemia (lack of oxygen and tissue death) of the spinal cord.
5. What are the long-term effects of the disorder?
Long-term effects of TM are variable and depend on the initial severity of TM, extent of the damage to the spinal cord, timeliness of the diagnosis, timeliness of the treatment initiation, ability to participate in physical therapy, patient’s age, and most importantly if TM is the initial presentation of an underlying disorder. Other effects include residual motor weakness, sensory changes, and bladder and bowel problems, and in a minority of patients with lesions at the thoracic level T6 or above, dysautonomia (loss of control of blood pressure). High cervical cord lesions extending into the brain stem may result in respiratory failure and ventilator dependence. In the long-term, some patients with TM may develop increased muscle tone leading to stiffness, painful muscle spasms and, in some cases, contractures. Pain can be a significant long-term effect of transverse myelitis.
6. Can anyone get TM, or only those with a genetic predisposition?
There is no specific genetic predisposition to an inflammatory transverse myelitis. Although the risks are low, anyone can develop transverse myelitis secondary to an aberrant immune response or infection.
7. Are there any ways to prevent yourself from getting TM?
Although exercising, eating a nutritious balanced diet and making sure your vitamin D levels are within normal range may significantly improve one’s overall health, currently there are no specific behaviors, diets, exercises or medications that can prevent transverse myelitis.
8. How many people does TM affect per year?
In the US, about 1400 new cases of transverse myelitis are diagnosed every year. Annual incidence of TM is estimated at 1.3 to 4.6 per million.
9. What kind of health care professionals see patients with TM?
Neurologists are the primary diagnosticians of transverse myelitis and are skilled in following and treating patients with TM. However, care of patients with TM frequently involves a multidisciplinary team consisting of a primary care physician, rheumatologist, urologist, physiatrist (rehabilitation doctors), physical and occupational therapists, social worker, nurses and nurse practitioners.
Thank you Dr. Grebenciucova! For more resources on TM, visit the resource library.