Transverse myelitis

Transverse myelitis is a rare neurological condition caused by inflammation (swelling) of the spinal cord. The swelling damages the nerves, and it can leave permanent scars or lesions.

These scars or lesions interrupt the communication between the nerves in the spinal cord and the rest of the body.

The word "transverse" means the swelling goes across the width of the spinal cord. Doctors also sometimes use it when the swelling affects only part of that width.

Transverse myelitis can cause a number of symptoms. These can include:

• muscle weakness in the legs, and sometimes the arms
• mobility problems
• unusual sensations and numbness
• bladder problems
• bowel problems
• sexual problems
• pain

Transverse myelitis can happen to anyone, at any time in their life. Most people have only one episode of symptoms, but sometimes it comes back again and again. It can also be the first sign of multiple sclerosis (MS) or another condition.

Transverse myelitis can have several different causes. In some people no cause can be found, and doctors then call it idiopathic transverse myelitis.

Sometimes transverse myelitis is caused by an autoimmune reaction. In autoimmune diseases, the immune system wrongly sees the body's own tissue as a danger and attacks it. This causes swelling, and the swelling damages the myelin sheath. The conditions that can do this include:

• MS-like swelling
• neuromyelitis optica (NMO)
• myelin oligodendrocyte antibody (MOG) associated myelitis
• sarcoidosis
• Sjogren's disease
• lupus

Transverse myelitis is sometimes caused indirectly by a viral infection, such as one of these:

• echovirus
• enterovirus
• Epstien-Barr
• hepatitis A
• herpes simplex
• HIV
• rubella
• influenza (flu)
• varicella zoster (the virus that causes chicken pox and shingles)

Most of the time, doctors can't identify the specific virus.

Bacterial infections, syphilis among them, can also lead to transverse myelitis.

Some cancers can set off an unusual response from the body's immune system, and this can lead to transverse myelitis.

See a doctor if you have symptoms of transverse myelitis.

If your doctor thinks you have transverse myelitis, they'll refer you to a neurologist (a specialist in conditions of the nervous system). The neurologist can arrange a specialist assessment.

Some of the tests you may need are:

• neurological examination
• magnetic resonance imaging (MRI) scan
• lumbar puncture
• blood tests

Sometimes your neurologist will do other tests to look for conditions that cause transverse myelitis. This might include CT scans.

Some people with transverse myelitis don't need any treatment, because it gets better on its own. Others do need treatment, either for the symptoms, for the swelling, or for whatever is causing the condition.

There are different treatments for the symptoms of transverse myelitis.

Physiotherapy can help improve:

• strength
• muscle spasms
• stiffness

Stretching exercises and similar techniques can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine to relax your muscles. This will usually be baclofen, gabapentin or tizanidine. All of these medicines have side effects, and you might get dizziness, weakness, nausea and diarrhoea. Talk with your doctor about which one would suit you best.

Mobility problems often come from muscle spasms and spasticity. Muscle weakness or problems with balance can also cause them. If you have trouble moving around, your doctor might suggest:

• an exercise programme supervised by a physiotherapist
• mobility aids, like a walking stick or a wheelchair
• home adaptations like stair lifts or railings

An occupational therapist can assess your home and suggest adaptations.

Sometimes your neurologist might offer treatment with steroids. This can help with some types of transverse myelitis. Steroids are only given for a short period, to avoid possible side effects. These could include:

• acid reflux (indigestion)
• stomach irritation
• worsening infection
• mood swings
• difficulty sleeping

Medicine might help if you have an overactive bladder, or if you need to pee often during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or a physiotherapist can help. Hand-held external stimulators help some people to start peeing or to empty the bladder. Sometimes a catheter can empty the bladder when needed, and you might be taught how to do intermittent self catheterisation (ISC). In rare cases, you may need a long-term catheter to keep the bladder emptying safely. You might also be referred to a continence adviser or a urologist for specialist treatment and advice.

Mild to moderate constipation may be treated by changing your diet or taking laxatives. More severe constipation may need suppositories, which are put into your bottom, or an enema. In an enema, liquid medicine is rinsed through your bottom and large bowel, which softens and flushes out your stools.

Anti-diarrhoea medicine or pelvic floor exercises might help with bowel incontinence.

You might be offered relationship counselling if you have:

• less interest in sex
• difficulty reaching orgasm

Or you might be offered an appointment with a sex therapist.

If you find it hard to get or keep an erection (erectile dysfunction), you may be prescribed medicine that increases the blood flow to the penis.

A physiotherapist might be able to help with this pain by suggesting exercises or better seating positions. If your pain is more severe, you may be prescribed painkillers. Or your doctor might suggest a transcutaneous electrical nerve stimulation (TENS) machine, which stimulates your nerves.

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also feel like extreme skin sensitivity, or a burning sensation. This type of pain can be treated with neuropathic painkillers.

Depending on what caused your transverse myelitis, you may be offered other treatments. Your neurologist will talk through the options with you.