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Tranverse myelitis is an inflammatory neurological condition that can occur in multiple sclerosis, vasculitis and other autoimmune conditions.
Typically, both sides of one segment of the spinal cord are affected. This causes inflammation to occur across the width of the spinal cord and symptoms to occur below the affected lesion.
Disease Process
In acute transverse myelitis, which occurs over hours or days, inflammation occurs in the gray and white matter in one or more adjacent segments of the spinal cord. The area of the spinal cord corresponding to the thoracic or chest cavity is the most likely area to be affected. Subacute conditions occur over a period of 1-2 weeks.
Attacks of inflammation in transverse myelitis can destroy or damage myelin, the fatty protective sheath that covers nerve cell fibers. Destruction of myelin interrupts communication between nerves in the spinal cord and the rest of the body.
Most patients have one episode of transverse myelitis although a few patients are known to have recurrences. In some cases, patients recover from acute attacks of transverse myelitis with minor or no residual problems. In other patients, transverse myelitis causes permanent symptoms. Although most patients with transverse myelitis do not develop multiple sclerosis, rarely, a rapidly progressive form of transverse myelitis is the first manifestation of multiple sclerosis.
Who is Affected?
Children as well as adults of all ages can develop transverse myelitis with the peak incidence occurring between the ages of 10-19 years and 30-39 years.
Symptoms
Transverse myelitis causes motor, sensory and sphincter problems on both sides of the body below the affected lesion. Symptoms include pain in the neck, head, or lower back. Sharp shooting pain may also radiate along the arms or legs or around the torso. In acute conditions, patients can also experience a tightening in the area of the chest and abdomen. Other symptoms include weakness, muscle spasms, fever, loss of appetite, gait disturbances including stumbling and dragging feet, numbness and tingling of the feet, toes and legs, and difficult urination.
Symptoms may progress causing a syndrome called transverse sensorimotor myelopathy. This syndrome, which occasionally recurs in patients with multiple sclerosis, systemic lupus erythematosus (SLE), or antiphospholipid syndrome (APS) can cause symptoms of paraplegia, urinary retention and fecal incontinence.
Causes
Transverse myelitis is caused by multiple sclerosis; infections (particularly Lyme disease, cytomegalovirus, chickenpox, mycoplasmal infection, tuberculosis, rubella, viral hepatitis, syphilis and viral meningoencephalitis); autoimmune conditions of vasculitis, SLE, Sjogren’s syndrome, sarcoidosis, and APS; abnormalities of blood flow or conditions of ischemia occurring in the spinal cord; vaccinations (especially to chickenpox and rabies), and certain drugs including amphetamines, intravenous heroin, antiparasitic and antifungal drugs. Post-infectious causes appear to be related to the immune system response to infection rather than to infection itself. Patients with vascular disease are usually older than 50 years and usually have heart disease or have recently had chest or abdominal operations.
Diagnosis
Transverse myelitis is diagnosed with magnetic resonance imaging (MRI) tests, cerebrospinal fluid analysis, and blood tests. MRI shows swelling of the spinal cord, and the cerebrospinal fluid shows increased protein and the presence of white blood cells.
Treatment
Treatment depends on the cause of the disorder. For instance, in infection antibiotics may be used. High doses of corticosteroids and plasma exchange are also use in autoimmune conditions.
Resources:
Transverse Myelitis Fact Sheet, National Institute of Neurological Disorders and Stroke
The copyright of the article Understanding Transverse Myelitis in Autoimmune Disease is owned by Elaine Moore. Permission to republish Understanding Transverse Myelitis in print or online must be granted by the author in writing.
Comments
Dec 3, 2008 7:35 AM
Guest
:
I'm 17 years old, have had TM, since I was 10 years old (2001) and I just
have to move on with my life as life goes on ... and I just wanted to let
people to know that life does go on no matter what ... am I wrong or am I
right? ... There are chances at walking again for people like you and
myself ... but the chances are very rare ... why the answer is unkowen at
this time of the year ... and I wish I could ansers it ... well untill I
could answer it ... Happy Holidays to all and god bless you all ... love
you all~~~!!!!
Jeremy Coursey
Dec 22, 2008 1:56 PM
Guest
:
Hi Jeremy, Happy holidays to you too. I am 45 and have SLE and APS with
recurring TM. Life does go on you are quite right. Nobody can do
absolutely everything. My trick is to narrow things down to what I can do
and enjoy that to the best of my ability. I agree it would be nice to
have some answers. I try and remember that the enlighted ones from all
races teach us to live in the moment. That helps me too. Hope Its
snowing wherever you are.
Kate Barlow
Jan 2, 2009 1:00 AM
Guest
:
Hi Jeremy and Kate,
I am 39 and was diagnosed with TM one year
ago. I still use my walker stroller for long distances as my legs get
fatigued easily. Or I use my cane for short distances when my legs feel
stronger. You are right, life does go on and we must make the best of
everyday. I am thankful for what I can do. Hope your holidays were great!
Happy New Year in 2009! Stay strong!
Saundra
Feb 11, 2009 7:28 AM
Guest
:
A True Life Story
By:
Jeremy Coursey
One morning I woke up to get ready for school. While I was in the
bathroom getting dressed my legs started to have a shooting pain up them.
Then all of a sudden I fell down and my legs didn’t work. I had to then
crawl up the stairs and push up on the couch. I screamed over and over and
over for my mom, and step – dad until they came, by this time my legs were
not working. My mom’s first reaction was she didn’t believe me so she
instantly took a needle, told me to close my eyes, and then started
sticking needle in the bottom of my feet and legs. Finally, what made her
quit it is my legs wouldn’t move at all.
My mom, and step – dad then
had to go get ready to take me to the emergency room. After my parents got
ready they came down to get me in the car, but wondered how they would do
this. So they decided to carry me. After a 40 to 45 minute drive to
Memorial Hospital we finally arrived and my Grandma Parson was waiting with
a wheel chair.
We got into the hospital and checked in, and had
to wait for about 10 to 15 minutes. I was sitting there freezing to death
finally I heard “Jeremy Coursey” I was anxious, scared, and worried of what
to expect.
The nurse then rolled me back into the exam room where
they put me on a stretcher and proceeded to take my vital signs. Then the
nurse started to ask my mom questions, and tell what to expect, which was
numerous tests including CAT scan’s and MRI’S. These machines might seem
scary to you, but all you should expect is some big loud noises. Usually
they will put headphones on you and talk to you throughout the testing
process. The test results took about 3 hours to come back! Why that long?
To make sure nothing was miss –diagnosed. Finally, the test results were
in the doctors came in sat down and said I had a disease that attacked my
spinal cord.
Feb 11, 2009 7:29 AM
Guest
:
Contined To My Story:
Transverse
Mellitus was the diagnosis. I lay there thinking, “Ok, now explain what I
really have” I had no clue what that big word meant; although I had a
pretty good idea that it meant something real bad! The doctors went on to
say that I had a 50/50 chance of ever walking again. Needless to say I was
shocked! It was like a dream that I was fighting to wake up from. Me being
a kid you would think that I would just bounce right back and eventually in
a few days or weeks I would be outside running and playing like all the
other kids. I thought that if I tried hard enough and concentrated hard
enough I could will my legs to move. My mom even had me close my eyes and
try this. Sometimes my toes did move but was told that was just a reflex
action. Each time I tried just wore me out mentally. I would strain so hard
and finally give up getting frustrated with myself thinking it was all my
fault and that I wasn’t trying hard enough.
Soon after finding
out the test results the doctors started the admitting process. I was in
for an almost one month stay in the hospital. It was no vacation! Day
after day learning how to live life in a wheelchair, still determined that
the doctors were wrong and yes; I would wake up from this dream. While in
the hospital there was a steady stream of visitors. Although I might not
have said it, these visits touched my heart and aided my healing process
more than they will ever know.
After weeks of stretch band,
massage, balancing (learning how to sit up straight in my chair),
transferring (moving back and forth from my chair to normal places like in
and out of bed, getting in and out of a car, and from my chair to the
shower) therapies, I was ready to re-enter the real world. My parents
decided to home school me for a while to keep me up on my studies and to
adjust to normal everyday activities. I can’t remember everything about my
first day back to school because it seemed like a whirlwind of questions,
activity changes, and explanations. That day floats back in my mind in
bits and pieces.
I remember waking up the day I was to go back
to public school. It was my birthday! I didn’t realize that I was going to
go back at “any time”. It was a very big birthday surprise when my parents
sprung that one on me. When we arrived to the school, which was just right
down the road, I had no clue that the whole school knew I was coming!
Feb 11, 2009 7:30 AM
Guest
:
"Page Three"
To my even greater surprise I was thrown a welcome back / birthday party
combined! My parents were really sneaky with this one and gave no clue of
what was in store for me that day. Wheeling my self down that long scary
hallway I entered a classroom. I was wondering, “why are the lights off?”
and before I could figure it out “SURPRISE!!” Screamed the whole class!
Before I could even think I was covered in Silly String! Yep, Silly
String! The kids covered me from head to wheel. I looked like a mummy!
It was my new classmates! They had all kinds of presents and cards for
me. The one thing I will never forget was the basketball cake with my name
on it that said “Welcome Back Jeremy”. I could have just jumped out of my
chair with joy because basketball was my favorite sport and with my name on
it “WOW!”
Feb 11, 2009 5:07 PM
Elaine Moore :
Hi Jeremy,
thanks for taking the time to write and share your story.
It'll help others. I know you're doing well. Best, Elaine
Feb 12, 2009 7:09 PM
Guest
:
I'm Joan Santiago, and I was diagnosed with TM this January 2009. I live in
the Philippines. I'm currently bed ridden and initially I could not move my
legs. Now I could wiggle them and move them a bit.. I'm on therapy
everyday.. I still hope I can walk.. I hate that I have to wear a
catheter.. it's the worse, I think of this sickness.
Here's my email:
luntianako@gmail.com
8 Comments
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