Transverse myelitis

A doctor will diagnose transverse myelitis based on your answers to questions about your signs and symptoms, your medical history, a clinical assessment of nerve function, and test results.

These tests, which may indicate inflammation of the spinal cord and rule out other disorders, include the following:

• Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create 3D images of soft tissues. An Magnetic resonance imaging (MRI) can show inflammation of the spinal cord and other potential causes of the symptoms, including abnormalities affecting the spinal cord or blood vessels.

• Lumbar puncture (spinal tap) uses a needle to draw a small amount of cerebrospinal fluid (CSF), the protective fluid that surrounds your spinal cord and brain.

  In some people with transverse myelitis, cerebrospinal fluid (CSF) may have abnormally high numbers of white blood cells or immune system proteins that indicate inflammation. Spinal fluid can also be tested for viral infections or certain cancers.

• Blood tests may include a test that checks for antibodies associated with neuromyelitis optica, a condition in which inflammation occurs both in your spinal cord and in the nerve in your eye. People with a positive antibody test are at increased risk of experiencing multiple attacks of transverse myelitis and require treatment to prevent future attacks.

  Other blood tests can identify infections that may contribute to transverse myelitis, or rule out other causes of symptoms.

Several therapies target the acute signs and symptoms of transverse myelitis:

• Intravenous steroids. You'll probably receive steroids through a vein in your arm over the course of several days. Steroids help reduce the inflammation in your spinal column.

• Plasma exchange therapy. People who don't respond to intravenous steroids may need plasma exchange therapy. This involves removing the straw-colored fluid in which blood cells are suspended (plasma) and replacing the plasma with special fluids.

  It's not certain how this therapy helps people with transverse myelitis, but it may be that plasma exchange removes inflammatory antibodies.

• Antiviral medication. Some people who have a viral infection of the spinal cord may be treated with medications to treat the virus.

• Pain medication. Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve.)

  Nerve pain may be treated with antidepressant drugs, such as sertraline (Zoloft), and anticonvulsant drugs, such as gabapentin (Neurontin, Gralise) or pregabalin (Lyrica).

• Medications to treat other complications. Your doctor may prescribe other medications as needed to treat problems such as muscle spasticity, urinary or bowel dysfunction, depression, or other complications associated with transverse myelitis.
• Medications to prevent recurrent attacks of transverse myelitis. People who have antibodies associated with neuromyelitis optica need ongoing medications, such as corticosteroids and/or immunosuppressants, to reduce their chances of more transverse myelitis attacks or developing optic neuritis.

Other therapies

Additional therapies focus on long-term recovery and care:

• Physical therapy. This helps improve strength and coordination. Your physical therapist can teach you how to use any needed assistive devices, such as a wheelchair, canes or braces.
• Occupational therapy. This helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
• Psychotherapy. A psychotherapist can use talk therapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioral issues from coping with transverse myelitis.

Prognosis

Although most people with transverse myelitis have at least partial recovery, it may take a year or more. Most recovery occurs within the first three months after the episode and strongly depends on the cause of transverse myelitis.

About one-third of people with transverse myelitis fall into one of three categories after an attack:

• No or slight disability. These people experience only minimal lingering symptoms.
• Moderate disability. These people are mobile, but may have difficulty walking, numbness or tingling, and bladder and bowel problems.
• Severe disability. Some people may permanently need a wheelchair and require ongoing assistance with daily care and activities.

It's difficult to predict the course of transverse myelitis. The prognosis and responsiveness to treatment is strongly determined by the cause of the syndrome and to some extent by how early treatment is administered. Generally, people who experience a rapid onset of severe signs and symptoms and those who have a positive test for a particular antibody have a worse prognosis than do those with a relatively slower onset, milder symptoms and negative antibody test.

Signs and symptoms that might indicate transverse myelitis are usually severe and sudden. You'll likely need emergency or urgent care.

Questions that the attending doctor is likely to ask include the following:

• When did you begin experiencing symptoms?
• How quickly have your symptoms developed?
• Do you have pain, tingling or other unusual sensations?
• How would you rate the pain on a scale of 1 to 10, with 10 being most painful?
• Have you experienced weakness or lack of coordination?
• Have you had problems with bowel or bladder control?
• Are you having difficulty breathing?
• Have you been diagnosed with other medical conditions?
• Have you recently had any infections?
• Have you recently had any vaccinations?
• Have you traveled abroad lately? Where?
• Have you had any medical procedures recently?
• What prescription or over-the-counter medications do you take regularly? What is the dosage of each?