Transverse myelitis (TM) is an inflammation of your spinal cord. It results from damage to nerve cells in your spinal cord.
Myelin is a fatty tissue that protects these nerve fibers. It fits around them like the insulation that covers an electrical wire.
When myelin is damaged, the nerves under it can be hurt, too. Once your nerves are scarred, it’s harder for them to send signals to other parts of your body the way they should. This often brings pain, weakness, or paralysis.
When this happens to the nerves on both sides of a segment of your spinal cord, it's known as transverse myelitis.
It might take months to years to recover from this condition, leaving minor problems for some people. But it also might cause serious and permanent problems affecting your ability to do simple, everyday tasks.
TM is rare, resulting in about 1,400 new cases a year in the U.S. Transverse myelitis can happen at any age but often occurs in people aged 10-19 years and 30-39 years. People assigned female at birth are at a higher risk of this condition.
Multiple sclerosis vs. transverse myelitis
Multiple sclerosis (MS) is a condition that affects the brain and spinal cord. It occurs when the immune system mistakenly attacks myelin in the brain, spinal cord, and eye nerves. Rarely, it can cause TM. When it does, symptoms usually appear on one side of the body. These symptoms can be the first ones that a person with MS shows. They may also happen as a sign of an MS relapse.
Idiopathic Transverse Myelitis
For the majority of people with TM, there's no known cause, and that's called idiopathic transverse myelitis. There may be an abnormal immune response against your spinal cord that causes the inflammation and damage associated with TM. But so far researchers haven't been able to find what triggers it.
Transverse Myelitis Causes
It's not clear what exactly causes TM. But scientists know it can happen when your immune system attacks healthy cells for some reason or when your body tries to fight off a disease, such as a viral, bacterial, or fungal infection. Mostly, it starts after you’ve recovered from an illness.
Your immune system releases inflammatory cells in response to an invading agent during an infection. Sometimes, the immune system releases inflammatory cells for no reason or sends out too many, leading to serious damage to the body. TM occurs when your spinal cord's nerve cells are damaged.
TM is often linked to:
Autoimmune conditions occur when the immune system works abnormally and attacks healthy cells, tissues, and organs. They include lupus, ankylosing spondylitis, antiphospholipid syndrome, Behçet’s disease, rheumatoid arthritis, and Sjogren's syndrome, all tied to TM.
- Bacterial infections such as Lyme disease, tuberculosis, and syphilis
- Fungal infections of the spinal cord, such as those caused by aspergillus, blastomyces, candida, coccidioides, and cryptococcus
- Parasitic infections such as toxoplasmosis, cysticercosis, schistosomiasis, and strongyloidiasis
- Viral infections such as those caused by varicella-zoster (which causes chickenpox and shingles), enterovirus, Zika virus, and West Nile virus
In rare cases, multiple sclerosis can cause transverse myelitis. When it does, the TM symptoms that show up are usually the first signs of MS. It can also signal an MS relapse.
Neuromyelitis optica (Devic's disease)
This condition causes inflammation in the eye and spinal cord nerves. TM from neuromyelitis optica usually affects both sides of the body. It may also cause symptoms involving your eyes, such as eye pain when you move them and temporary vision loss.
Various vaccines have been reported to trigger TM. But this rarely happens, and there isn’t enough evidence to reduce recommended vaccinations.
TM may be caused by sarcoidosis, a condition that causes inflammation in your body. Spinal cord sarcoidosis is rare, and less than 1% of sarcoidosis cases involve the spinal cord.
Transverse Myelitis Symptoms
Symptoms may show up in a few hours or days (your doctor will call this an acute attack). Or you might notice them gradually over a few weeks (this is called subacute). While the condition isn’t chronic, TM can come back if you have a history of autoimmune disease.
The first symptoms of TM are usually:
- Pain in your back
- Sharp pain that moves down your legs and arms or around your chest and belly
- Weakness or paralysis in your legs or arms
- Sensitivity to touch, to the point where slight fingertip pressure causes pain
- Numbness or a pins-and-needles feeling in your toes, feet, or legs
- Muscle spasms
- Loss of appetite
- Bladder and bowel control issues, such as an increased urge to use the toilet, constipation, or incontinence
- Sexual dysfunction
- Loss of appetite
- Breathing problems
Once they start, symptoms can get worse within hours. Most of the time, they peak within 10 days. At that point, about half the people who get TM lose control of their legs.
How much of your body is affected depends on which part of your spinal cord has the problem. The higher it is, the more problems you’ll have.
Abnormal sensations caused by transverse myelitis
TM can cause abnormal sensations in the legs, back, belly, and arms that feel numb, tingle, burn, tickle, or prick. You might also have sensory loss altogether.
Transverse Myelitis Diagnosis
Your doctor will run tests to find out if you have TM or other conditions.
MRI or CT scans
These tests create detailed images of your insides. They’ll show the doctor if something else is affecting your nerves, such as a tumor, slipped disk, or narrowing of the channel that holds your spinal cord. An MRI can show demyelination, a sign of MS.
For this test, your doctor puts a needle between two vertebrae (bones in your back) to take a sample of the fluid surrounding your brain and spinal cord. You might have an infection if it has more disease-fighting white blood cells or certain proteins than it should. That may be a sign of TM.
Transverse Myelitis Treatment
There's no cure for TM, so your doctor will try to manage the disease and ease your symptoms. They may suggest:
They’ll ease inflammation in your spine. You might get pills, or your doctor will inject steroids directly into your veins.
Intravenous immunoglobulin (IVIG)
Your doctor will inject antibodies from healthy donors into your system. They’ll bind to your problem-causing antibodies and take them out of circulation.
Plasma exchange therapy
If steroids don’t lower your inflammation, this treatment, also called plasmapheresis, might. Your doctor will replace your blood plasma (the liquid part that holds the blood cells) with special fluids. This removal might get rid of something that's causing your immune system to attack your body and keep it from damaging other organs.
You’ll take them if your doctor thinks a virus is causing your illness.
Management of urinary function
Treatments to help control your bladder may include:
- Timed peeing
- Condom catheters (external catheter)
- Clean intermittent urinary catheterization
- Padded underwear
- A catheter left in the bladder
Sexual dysfunction treatments
Sexual dysfunction treatment may help improve symptoms such as difficulty getting an erection in people assigned male at birth and improve sexual function for people assigned female at birth. They include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
Over-the-counter pain medicines
Acetaminophen, ibuprofen, and naproxen can all help.
Prescription pain medication
Ventilator with a breathing tube
If your symptoms affect your breathing, this machine can help you breathe. It’ll make sure your body gets enough oxygen.
Nonmedical Treatments for Transverse Myelitis
Your doctor might also suggest:
You might need to stay in bed while you fight the illness.
- Ways to keep your muscles strong and your limbs flexible while you recover
- Techniques to control your bowels and bladder
- How to use tools that make life easier, such as wheelchairs, canes, or braces
Occupational therapy will teach you new ways to do daily chores, such as cooking dinner, taking a bath, getting dressed, or cleaning the house.
Vocational therapy can help you find a job that suits your abilities or work with your employer to make necessary changes.
Transverse Myelitis Complications
Transverse myelitis may cause complications, the most common of which include:
Pain: It’s both a symptom and a lasting complication.
Spasticity: This includes stiff, tight, and spasming muscles. It’s most common in your legs and bottom.
Sexual problems: Those assigned male at birth may have trouble getting an erection. Anyone with TM could have difficulty reaching orgasm.
Depression or anxiety : Between the changes this disease makes to your body, the stress of living with it, the pain, and the sexual troubles, there’s a lot to handle. Talk to your doctor or a mental health professional for support.
What’s the Outlook?
About 1,400 people a year get TM, and about 33,000 people have some sort of disability as a result.
About a third of people with TM get better and don't have much permanent damage. They can walk normally and have only small lingering issues.
Another third have trouble walking. They also may have muscle spasms, a less sensitive sense of touch, or trouble controlling their bladder.
The remaining third are no longer able to walk and need help with many everyday activities.
Doctors don’t know why TM affects some people more than others. They do think that the faster your symptoms show up, the harder it may be for you to recover. Early treatment and physical therapy can help.
Transverse myelitis is a rare but serious condition that damages the nerve cells in your spinal cord, affecting your ability to participate in daily activities. Although TM isn't long-lasting and only occurs once in most people, it can cause health problems after recovery. Your doctor can create a treatment plan to manage your symptoms and improve how well you recover. You may also get treatment that helps address any residual problems from TM.
Transverse Myelitis FAQs
Can you fully recover from transverse myelitis?
Yes, you can fully recover from transverse myelitis and have no symptoms after it.
Is transverse myelitis life-threatening?
Transverse myelitis isn’t life-threatening but can cause disabilities that can reduce your quality of life.
What are the first symptoms of transverse myelitis?
Transverse myelitis's first and typical symptoms are leg and arm weakness, lower back and leg pain, abnormal sensations in the legs and genital area, and bowel and bladder problems.
Is transverse myelitis contagious?
While no one knows precisely why it happens, transverse myelitis isn’t contagious.