Transverse myelitis

Transverse myelitis is a rare neurological condition. It’s caused by inflammation (swelling) of the spinal cord. The swelling damages the nerves and can leave permanent scars or lesions.

The scars or lesions interrupt the communication between the nerves in the spinal cord and the rest of the body.

‘Transverse’ refers to the swelling being across the width of the spinal cord. It’s also sometimes used to describe swelling that only affects part of the width of the spinal cord.

Symptoms of transverse myelitis

The symptoms of transverse myelitis can include:

• muscle weakness in the legs, and sometimes the arms
• mobility problems
• unusual sensations and numbness
• bladder problems
• bowel problems
• sexual problems
• pain

Transverse myelitis can happen to anyone at any time in their life. In most cases there might only be one episode of symptoms, but sometimes it can happen repeatedly. Transverse myelitis can be the first sign of MS or another condition.

Causes of transverse myelitis

There are several different causes of transverse myelitis. Sometimes a cause isn’t found, and this is called idiopathic transverse myelitis.

Autoimmune disease

Sometimes transverse myelitis is caused by an autoimmune reaction. In autoimmune diseases, the immune system mistakes the body’s own tissue as dangerous and attacks it. This causes swelling that results in damage to the myelin sheath. This includes:

• MS-like swelling
• neuromyelitis optica (NMO)
• myelin oligodendrocyte antibody (MOG) associated myelitis
• sarcoidosis
• Sjögrens syndrome
• lupus

Viral infection

Sometimes transverse myelitis is caused indirectly by a viral infection, although often the virus responsible isn’t identified.

Transverse myelitis often develops after a viral infection like:

• echovirus
• enterovirus
• Epstien-Barr
• hepatitis A
• herpes simplex
• HIV
• rubella
• influenza (flu)
• varicella zoster (the virus that causes chicken pox and shingles)

Bacterial infection

Bacterial infections such as syphilis might also lead to transverse myelitis.

Cancer

Some cancers might trigger an unusual immune response that can lead to transverse myelitis.

Diagnosing transverse myelitis

If your GP thinks you could have transverse myelitis, you should see a neurologist (a specialist in conditions of the nervous system) for a specialist assessment.

Some of the tests you may need to confirm transverse myelitis are:

• neurological examination
• magnetic resonance imaging (MRI) scan
• lumbar puncture
• blood tests

Sometimes your neurologist will do other tests to look for conditions that cause transverse myelitis. This might include CT scans.

Treating transverse myelitis

Sometimes transverse myelitis requires no treatment as it will improve on its own. Sometimes patients may require treatment for their symptoms, the swelling, or the underlying cause.

Treatment for transverse myelitis symptoms

There are different treatments available for transverse myelitis symptoms.

Muscle weakness

Physiotherapy can help improve strength, and the muscle spasms and stiffness that may sometimes develop.

Techniques such as stretching exercises can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine.

These medicines all have side effects. You might experience dizziness, weakness, nausea and diarrhoea. Discuss which of these would be best for you with your healthcare professional.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, or problems with balance can also cause mobility problems.

If you have problems with mobility, your healthcare professional might suggest:

• an exercise programme supervised by a physiotherapist
• mobility aids, such as a walking stick, or a wheelchair
• home adaptations such as stair lifts or railings

An occupational therapist can carry out an assessment of your home and suggest adaptations.

Treatment of the inflammation (swelling)

Sometimes your neurologist might offer treatment with steroids. This can help with some types of transverse myelitis. Steroids are only given for a short period of time to avoid possible steroid side effects. The side effects could include reflux and stomach irritation, worsening infection, mood swings, and difficulty sleeping.

Bladder problems

Medication might help if you have an overactive bladder or need to pee frequently during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder.

Sometimes a catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC).

In rare cases, people with transverse myelitis may need a long-term catheter to keep the bladder emptying safely.

You might be referred to a continence adviser or urologist, for specialist treatment and advice. Read more about treating urinary incontinence.

Bowel problems

It might be possible to treat mild to moderate constipation by changing your diet or taking laxatives.

More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. During an enema, liquid medication is rinsed through your bottom and large bowel, which softens and flushes out your stools.

Anti diarrhoea medication or pelvic floor exercises might help bowel incontinence.

Sexual problems

If you experience problems with less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help.

If you have transverse myelitis and find it hard to get or maintain an erection (erectile dysfunction) you may be prescribed medication to increase the blood flow to the penis.

Musculoskeletal pain

A physiotherapist might be able to help with this pain by suggesting exercises or better seating positions.

If your pain is more severe, you may be prescribed painkillers. Or, you might have a transcutaneous electrical nerve stimulation (TENS) machine that stimulates your nerves.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation.

This type of pain can be treated using neuropathic painkillers.

Other treatments for transverse myelitis

You may be offered other treatments depending on the cause of your transverse myelitis. Your neurologist will discuss your options with you.