What Is The Link Between Transverse Myelitis and Multiple Sclerosis?

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Transverse myelitis is an inflammatory condition that occurs when a person's own immune system attacks their spinal cord at one level or segment. This misguided attack damages myelin, which is a fatty sheath that covers nerve fibers.

Since myelin allows for the transmission of rapid nerve impulses, if damaged, the affected nerves in the spinal cord cannot communicate well with the rest of the body. This may then lead to a variety of symptoms, such as sensory or movement problems and bladder/bowel dysfunction.

The connection between transverse myelitis and multiple sclerosis (MS) is interesting because while transverse myelitis may occur on its own, it can also occur as a result of an underlying disease process, like MS.

In fact, transverse myelitis is sometimes the first clue that a person even has MS, or that they will develop MS in the near future.

Symptoms

Transverse myelitis can develop rather suddenly, like over hours to days, or slowly, over one to four weeks.

The symptoms of transverse myelitis may include the following:

  • Sensory disturbances: Most people experience a girdle or band-like feeling around their trunk that may be sensitive to touch; abnormal sensations (for example, burning, numbness, or tingling) are then felt below the "'band."
  • Weakness: Muscle weakness usually begins in the legs (complete or partial paralysis may occur) and may spread to the arms.
  • Bladder and bowel problems: Issues may range from increased urinary frequency and incontinence to difficulty urinating and constipation.
  • Pain: The pain is often described as sharp and occurs in the back, extremities, or abdomen.
  • Other: Other potential symptoms include sexual dysfunction, fatigue, and depression.

Location Matters

The location of transverse myelitis symptoms depends on what segment or level of the spinal cord at which the inflammation occurs. For instance, inflammation in the mid-back generally spares the arms but cause impaired leg sensation/movement and bowel and bladder dysfunction.

Types

There are a few different types of transverse myelitis—and the type that a person has influences their risk for eventually developing MS:

  • Partial transverse myelitis
  • Complete transverse myelitis
  • Longitudinally extensive transverse myelitis (LETM)

Partial transverse myelitis means that the inflammation across the spinal cord is patchy or not fully complete, so symptoms below the spinal segment tend to be milder and asymmetric.

Complete transverse myelitis means that there are complete or near-complete neurological deficits seen below the inflamed spinal cord segment.

Longitudinally extensive transverse myelitis means that the inflammation is equal to or longer than three spinal segments—so an alarmingly more widespread, severe inflammation of the spinal cord.

Research has found that up to one-third of people with partial transverse myelitis with a normal brain magnetic resonance imaging (MRI) eventually develop MS over the following five to ten years.

Interestingly, the individuals who eventually develop MS are more likely to experience sensory symptoms (as opposed to movement or motor symptoms like muscle weakness) with their transverse myelitis.

Children too who develop partial transverse myelitis are at five times higher risk of eventually being diagnosed with MS compared to children with complete transverse myelitis. 

The third subtype of transverse myelitis—LETM—is rarely associated with MS, and is more strongly associated with a neurological condition called neuromyelitis optica (NMO).

Causes

It's important to understand that MS is just one potential lingering cause behind transverse myelitis. Other whole-body inflammatory illnesses may cause transverse myelitis like Sjogren's syndrome, systemic lupus erythematosus, or neurosarcoidosis.

Besides an underlying disease, other potential causes of transverse myelitis include an autoimmune reaction to:

  • A cancer that damages the nervous system
  • A viral infection (for example, the virus that causes chickenpox or shingles, called varicella-zoster)
  • A bacterial infection (for example, the bacteria that can cause pneumonia, called Mycoplasma pneumoniae)
  • A fungal infection (for example, Aspergillus fumigatus)
  • A parasitic infection (for example, Toxoplasma gondii)

Diagnosis

The diagnosis of transverse myelitis involves a medical history and neurological examination, along with imaging tests, most notably a magnetic resonance imaging (MRI) of the spine.

An MRI of the spine can confirm the inflammation within the spinal segment and be used to rule out alternative diagnoses, such as a herniated disc or spinal stenosis, as well as diagnoses, like spinal cord compression from cancer, that require emergent medical attention.

Blood tests to rule out infection or vitamin deficiencies (e.g., vitamin B12 and copper) and/or a spinal tap to look for markers of inflammation (e.g., high white blood cell count in the cerebrospinal fluid), may also be performed.

Treatment

The primary goal of treatment for transverse myelitis is to alleviate inflammation of the spinal cord with high doses of intravenous (through the vein) corticosteroid therapy. In cases where a person does not respond to corticosteroid therapy, plasmapheresis may be performed.

Corticosteroid therapy is also used to treat MS relapses; less commonly, plasmapheresis is used to treat an MS relapse (reserved for those who do not respond to steroids).

Various rehabilitation therapies, most notably occupational and physical therapy, are also an essential component for treating transverse myelitis. Some people may require inpatient rehabilitation.

A Word From Verywell

The take-home message here is that while transverse myelitis may occur spontaneously, it can also occur as a result of an underlying disease process—and MS is a classic one. In fact, transverse myelitis, especially partial transverse myelitis, may even be the first clue of a looming MS diagnosis.

If you or a loved one has been diagnosed with transverse myelitis, it's important to discuss close follow-up and monitoring (often with brain MRIs) with your neurologist.

If you do end up having MS, starting a disease-modifying medication promptly is key to slowing down your disease and delaying the progression of any disability.

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