What is transverse myelitis?

Transverse myelitis (TM) is a condition that causes inflammation in your spinal cord. It is sometimes the first sign of multiple sclerosis.

Symptoms can include weakness in your legs or arms that gets worse over days or weeks.

Transverse myelitis is uncommon. It affects females more than males and can happen in both adults and children.

What are the symptoms of transverse myelitis?

Symptoms of transverse myelitis usually develop over days or weeks. They usually affect both sides of your body but not your face.

Symptoms can include:

• weakness in your arms and legs, or just your legs
• feelings of tingling or numbness
• bladder problems — needing to urinate (wee) more than usual, sudden urges to urinate, incontinence (where you can't control your bladder) or not being able to urinate
• bowel problems — including constipation or faecal incontinence (where you can't control your bowel)

You can also have pain. This may be a constant and severe pain in the middle of your back or muscle spasms and pain in your arms and legs.

What causes transverse myelitis?

There are several causes of TM. The most common causes are multiple sclerosis and a condition called 'neuromyelitis optica spectrum disorder'.

TM may also be caused or triggered by:

• infections — bacterial, fungal, parasitic and viral infections
• having a vaccination — this is rare
• conditions such as lupus, sarcoidosis and Sjogren's syndrome
• some cancers that lead to an unusual response from your immune system

Sometimes the exact cause of TM is unknown.

When should I see my doctor?

Go to your closest emergency department if you have:

• weakness in any of your limbs
• shooting pains or sensation changes in your arms or legs
• problems with bowel or bladder function

If you have milder, ongoing symptoms, you should see your doctor.

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How is transverse myelitis diagnosed?

Your doctor will ask about your symptoms and examine you. They may recommend tests to help make the diagnosis and find out the cause.

Your doctor may also refer you to a neurologist (a doctor who treats conditions of the brain and nerves) for diagnosis and treatment.

Tests for transverse myelitis can include:

• blood tests
• an MRI scan of your brain and spinal cord
• a lumbar puncture

During a lumbar puncture, your doctor will take a sample of your spinal fluid. They will send it to the lab to help make the diagnosis and find a cause for your condition.

How is transverse myelitis treated?

The aim of treatment for transverse myelitis is to:

• treat your symptoms
• prevent and treat complications
• prevent relapse

Initial treatment

Initial treatment may be in hospital with corticosteroid medicines. The medicine is given intravenously (through a vein) for 3 to 5 days. It helps reduce the swelling and inflammation in your spinal cord.

Plasmapheresis (plasma exchange therapy) can help if you don't respond well to corticosteroid therapy or if your symptoms are severe.

Ongoing treatment and follow up

Ongoing treatment may be needed to prevent another episode of TM. This may include medicines to suppress your immune system or longer-term corticosteroid medicines.

Recovery depends on several factors. Some people have a complete recovery, while others can have ongoing problems.

Follow-up will be needed with your doctor, usually for at least 6 to 12 months.

Your doctor may also recommend you see a:

• physiotherapist — to help improve movement, function and strength
• occupational therapist — if you need help to move around
• continence advisor

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What are the complications of transverse myelitis?

Complications of TM can include:

• ongoing weakness and muscle problems that affect how you move around
• neuropathic pain (nerve pain)
• ongoing bladder or bowel problems
• blood clots in your legs

Can transverse myelitis be prevented?

There is no definite way to prevent TM. However, good hygiene practices and vaccination may help you avoid some infections. This may lower your chance of developing TM.

Also, managing any autoimmune conditions will lower your chance of TM happening again.

Resources and support

The Brain Foundation has information about transverse myelitis.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.