Transverse myelitis (TM) is a rare autoimmune disease in children that causes damaging inflammation (swelling) of the spinal cord and several complications in the body and nervous system.
What is Transverse Myelitis?
The spinal cord is the information highway that connects the brain to the rest of the body. Swelling in the spinal cord damages the myelin around the nerves (demyelination). Myelin acts as insulation (like a plastic covering on electrical wires), allowing the body’s electrical impulses that control normal functions to activate. When the myelin is damaged, it can slow down the body’s internal communication that manages movements and reactions, and in this case, vision.
When TM causes swelling in the spinal column, it interrupts motor and sensory sections along both sides of the column, often leading to several disruptive and sometimes potentially life-threatening symptoms.
Approximately 1,400 new cases of TM are diagnosed each year, affecting children and adults ages 6 months to 88 years; roughly 25% of cases impact children. Studies have shown a spike of diagnoses between ages 10 to 19 years and 30 to 39 years. Up to 90% of TM cases are monophasic (one time), but some may have a recurrence (return of a symptom or disease after remission or disappearance).
What are the signs and symptoms of Transverse Myelitis?
Signs of TM can range in location and severity, depending on where the spinal cord was damaged. Symptoms include:
- Autonomic dysfunction (involuntary, but essential body functions like breathing, heart beating, digesting food and reflexes)
- Bladder and bowel problems
- Decreased joint position sense (ability to know where and how joints move when you can’t see them)
- Decreased pain sensations (the brain doesn’t recognize pain, even if an injury has occurred)
- Decreased pallesthesia (ability to sense vibrations)
- Decreased temperature sensations
- Fatigue (tiredness)
- Feeling is decreased below the section of spinal damage
- Increased pain in the arms, abdomen, back and legs
- Muscle weakness or paralysis
- Paresthesia (tingling, numbness or burning sensations)
- Sensitivity or a tight feeling around the torso (abdomen, back and chest)
- Sexual issues
- Spasticity (involuntary, continually tense muscles)
What are the potential causes of Transverse Myelitis?
The exact cause of TM is unknown; research has shown several possible risk factors that can lead to the disease. Sometimes it can occur by itself, or it can happen along with another condition.
- Autoimmune diseases – In some cases, the inflammation may be triggered by an autoimmune response when the body accidentally attacks its own spinal cord, causing nerve and tissue damage. In rare occurrences, TM is associated with other autoimmune diseases like systemic lupus erythematosus (SLE), Sjogren’s syndrome (makes eyes and the mouth dry), and sarcoidosis (small, round growths that can grow in eyes, lymph nodes, lungs and skin).
- Viral and bacterial diseases and infections – If your child has another condition, especially anything with a rash, it can also trigger an autoimmune response. Associated conditions include rubella (measles), varicella (chicken pox), variola (smallpox), rubella (German measles), influenza and mumps. In some cases, the infection will enter and directly infect the spinal cord like poliomyelitis (polio), herpes zoster (shingles), AIDS, and Lyme neuroborreliosis (Lyme disease that affects the central nervous system).
Transverse Myelitis Doctors and Providers
Jonathan Cheng, MD Pediatric Hand Surgeon