Transverse myelitis (TM) is a disorder caused by inflammation in the spinal cord. The spinal cord carries nerve signals to and from the brain to the rest of the body. In TM the immune system causes inflammation of myelin, the fatty coating that insulates nerve cells, as well as the nerve cells themselves. This damage disrupts the messages the spinal cord nerves send throughout the body, which can result in pain, sensory problems, muscle weakness, and loss of bladder/bowel control.

Transverse myelitis can affect patients of any age, gender or race. An estimated 1,400 new cases of TM are diagnosed each year.

Signs and symptoms of transverse myelitis

Transverse myelitis symptoms usually evolve over several hours to days, but may progress over as long as one to two weeks.

Typical symptoms of TM include:

• Weakness in the legs and arms. This may progress to inability to walk or even total paralysis.
• Pain, which may begin suddenly in the lower back. Shooting pain down the legs or arms, chest or abdomen may occur as well.
• Abnormal sensations, such as numbness, tingling, burning and coldness.
• Band-like sensation across the trunk of the body
• Bladder and bowel problems, including the need to urinate more frequently, incontinence, or difficulty urinating and constipation.

In some cases, dangerous complications can include unregulated changes in vital signs such as heart rate and blood pressure, or even trouble breathing due to muscle weakness. A TM attack is a medical emergency and needs to be treated promptly.

What causes transverse myelitis?

TM is an autoimmune or post-infectious disorder causing inflammation and damage to the spinal cord. As with other autoimmune diseases, the process that instigates the inflammation is unknown. A number of conditions are associated with TM. These include:

• Autoimmune disorders such as multiple sclerosis, neuromyelitis optica, systemic lupus erythematous or Sjogren’s syndrome
• Viral infections, such as varicella zoster (the virus that causes chickenpox and shingles), herpes simplex, West Nile virus, influenza, hepatitis B, mumps, measles and rubella
• Bacterial infections, including tuberculosis and Lyme disease

Testing and diagnosis of transverse myelitis

Your child’s doctor will take a complete medical history and give your child a thorough neurological exam. Your doctor will also order diagnostic tests to confirm a transverse myelitis diagnosis and help rule out other diseases.

These tests may include:

• An MRI to look for inflammation within the spinal cord and rule out areas of damage in the brain
• Blood tests to rule out other disorders, check for infections, and test for autoantibodies that may be found in people with TM
• A lumbar puncture (spinal tap), which may show elevated levels of white blood cells and protein, indicators of inflammation in the spinal fluid

Transverse myelitis treatment

Treatment of transverse myelitis is aimed at reducing inflammation, managing symptoms, and addressing infections that may cause the disorder.

Your child may receive intravenous corticosteroids to decrease swelling and inflammation. Other treatments include antibody infusions (IVIg) from healthy blood donors, or plasmapheresis, a process in which the blood is filtered through a machine to remove the antibodies causing the autoimmune response. Pain medicines may be given for comfort as well.

Outlook for transverse myelitis

The outcome of patients with transverse myelitis is variable. Most people with TM recover at least partially and within the first three months after the attack, though some patients may take two years or longer to recover. Rapid onset of symptoms generally results in poorer recovery. Some individuals have lingering complications such as pain, incontinence, and partial or total paralysis. Physical, occupational, and vocational therapy can help people adjust to these disabilities.

Most patients with TM do not have recurrent attacks, though some people have relapses of TM when multiple sclerosis or neuromyelitis optica is the underlying cause.

Why choose CHOP for transverse myelitis care?

At Children’s Hospital of Philadelphia (CHOP), your child will see a team of experts who specialize in demyelinating diseases like TM. Your child’s care team will include a neurologist, nurse practitioner, nurse, occupational therapist, physical therapist and social worker. We partner with other specialties within CHOP such as ophthalmology, urology, pain management, and neuropsychiatry to coordinate your child’s care.

Our team members are actively involved in research about TM. Interested families will have the opportunity to be involved in research to help us learn more about the treatment and outcomes of TM and related disorders.