Myelitis

Description

Transverse myelitis (TM) is an inflammation or infection of the spinal cord in which the effect of the lesion spans the width of the entire spinal cord at a given level. The spinal cord consists of four regions: the cervical (neck), followed by the thoracic (chest), the lumbar (lower back) and the sacral (lowest back). TM can occur in any of these regions. The disease is uncommon, but not rare, as it occurs in one to five persons per million population in any given year in the United States. It is equally diagnosed in both adults and children. TM may occur by itself or in conjunction with other illnesses such as viral or bacterial infectious diseases, autoimmune diseases such as multiple sclerosis, vascular illnesses such as thrombosis, and cancer.

The symptoms of TM depend on the level of spinal cord lesion with sensation usually diminished below the spinal cord level affected. Some patients experience tingling sensations or numbness in the legs with bladder control also being disturbed. The condition is usually diagnosed following magnetic resonance imaging (MRI) or computed tomography (CT) with "spinal taps" (lumbar punctures) taken for additional analysis. Recovery depends on the general health status of the patient and is usually considered unlikely if no improvement is observed within three months.

Causes

The exact cause of TM is unknown but research results point to autoimmune deficiencies, meaning that the patient's own immune system abnormally attacks the spinal cord, resulting in inflammation and tissue damage.

There is also evidence suggesting that TM occurs as a result of spinal cord compression by tumors or as a result of direct spinal cord invasion by infectious agents, especially the human immunodeficiency virus (HIV) and the human T-lymphotropic virus type I (HTLV-1).

TM is also listed among the spinal cord disorders occurring in patients diagnosed with AIDS.

Treatments

There is no specific treatment for transverse myelitis. Treatment of the illness is largely symptomatic, meaning that it depends on the specific symptoms of the patient. The region in which the spinal cord has been infected is critical but a course of intravenous steroids is generally prescribed at the onset of treatment.

Treatment of the bladder function impairment resulting from TM include drugs, external catheters for men and padding for women, with surgery recommended in certain cases. A common TM side effect is difficulty with stool evacuation and this condition can be treated by diets that include stool softeners and fiber.

As a result of TM, muscle groups below the affected level may become spastic. Treatment of spasticity usually involves prescriptions of drugs such as Baclofen (Lioresal), which stops reflex activity, and Dantrolene sodium (Dantrium) which acts directly on muscle. A new very well-tolerated drug, Tizanidine, has also recently been introduced in the United States. Muscle pain is generally treated with analgesics such as acetaminophen (Tylenol) or ibuprofen (Naprosyn, Aleve, Motrin). Nerve disorders might be treated with anticonvulsant drugs such as carbamazepine, phenytoin or gabapentin (Tegretol, Dilantin, Neurontin).

Alternative and complementary therapies

Individuals with TM may experience serious difficulty with common tasks such as dressing, bathing and eating. Complementary TM therapies may accordingly include a course of physical therapy so as to help patients recover mobility. This can be achieved with special exercises, canes, walkers and custom-designed braces.

After the acute phase, people with TM start the rehabilitation process. During this period, the focus of care is shifted from designing an effective TM treatment to learning to cope with a serious disease. TM patients must learn to cope with the loss of abilities which healthy people take for granted and this process is necessarily harder if TM is associated with AIDS or another serious autoimmune disease. Resources that may help this required adjustment are psychological assistance from counselors, relatives and friends, and making contact with TM support groups. The Transverse Myelitis Association may also be contacted: 3548 Tahoma Pl. West, Tacoma, WA 98466-2141 (info@myelitis.org; www.myelitis.org) Phone:253-565-8156.

KEY TERMS

Autoimmune disease

An illness which occurs when the body tissues are attacked by its own immune system. The immune system is a complex defense mechanism of the body whose primary function is to seek out and destroy invaders of the body, especially infections.

Catheter

A tubular, flexible instrument used to withdraw fluids from a body cavity, especially urine from the bladder.

Infectious disease

A disease caused by a virus or a bacterium. Examples of viruses causing an infectious disease are: HIV-1 virus, herpes simplex, cytomegalovirus, Epstein-Barr virus, leukemia virus. Examples of bacterial infectious diseases are: syphilis and tuberculosis.

Spinal cord

Elongated part of the central nervous system of vertebrates that lies in the vertebral canal and from which the spinal nerves emerge.

Spinal cord compression

A condition resulting from pressure being applied on the spinal cord, as from a tumor or spinal fracture. Depending on the location of the pressure, symptoms may include pain, numbness, tingling and prickling sensations as well as lock of sensory or motor functions.

Spinal tap

A diagnostic procedure by which a needle is introduced into the lower spine to collect cerebrospinal fluid for diagnostic testing.