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Rare Diseases 2023

Transverse myelitis: what é, symptoms, causes and treatment

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Transverse myelitis: what é, symptoms, causes and treatment
Transverse myelitis: what é, symptoms, causes and treatment

Transverse myelitis, or just myelitis, is an inflammation of the spinal cord that can occur as a result of infections by viruses or bacteria, or be a consequence of autoimmune diseases.

The main signs and symptoms of this condition are due to bone marrow involvement and, therefore, the most common include muscle paralysis, back pain, muscle weakness, decreased sensitivity and paralysis of the legs and/or arms.

Treatment for myelitis aims to promote the person's quality of life and should be indicated by a neurologist. Usually, the doctor recommends performing specific treatment for the cause of myelitis, but may also recommend physical therapy sessions to stimulate muscle movement and prevent paralysis.

Main symptoms

The symptoms of transverse myelitis arise due to the involvement of the peripheral nerves of the spine, and there may be:

  • Spine pain, especially in the lower back;
  • Tingling or burning sensation in chest, abdomen, legs or arms;
  • Weakness in arms or legs, with difficulty holding objects or walking;
  • Forward head tilt, and difficulty swallowing;
  • Difficulty holding back urine or stool.

Since myelitis can affect the myelin sheath of nerve cells, the transmission of nerve stimuli is more impaired over time and, therefore, it is common for symptoms to get worse every day, making become more intense and may even lead to limb paralysis.

When the affected portion of the spine is lower, it is possible for the person to lose movement in the legs, and when the affected area is close to the neck, the affected person may lose movement in the shoulders and arms. In the most severe cases, there may still be difficulty in breathing and swallowing, requiring hospitalization.

How to confirm the diagnosis

The initial diagnosis is usually performed by the general practitioner or orthopedist based on the evaluation of the signs and symptoms presented by the person. In the case of suspected transverse myelitis, it is usually indicated that the person consults the neurologist for a complete diagnosis and the best treatment to be initiated.

So, the doctor, in addition to evaluating the symptoms and the history of diseases, usually also asks for some diagnostic tests, such as MRI, lumbar puncture and various blood tests, which help to make the differential diagnosis and confirm the diagnosis of transverse myelitis.

Possible causes

Transverse myelitis is a rare situation but it can happen as a consequence of some situations, the main ones being:

  • Viral infections, especially in the lung (Mycoplasma pneumoniae) or digestive system;
  • Enteroviruses, such as EV-A71 and EV-D68;
  • Rhinovirus;
  • Parasitic infections such as toxoplasmosis or cysticercosis;
  • Multiple Sclerosis;
  • Optical neuromyelitis;
  • Autoimmune diseases such as lupus or Sj√∂gren's syndrome.

Although it is very rare, there have also been reports of cases of transverse myelitis arising after taking a vaccine against hepatitis B or against measles, mumps or chicken pox.

Transverse myelitis and COVID-19 vaccination

The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) recommends the addition of transverse myelitis as one of the possible side effects of the Janssen and Astrazeneca COVID-19 vaccines [1]This recommendation came after the evaluation of some recorded cases of people who developed transverse myelitis after vaccination.

Still, the EMA guarantees that the benefit of vaccination is much greater than the risk offered by transverse myelitis, and the use of vaccines should be maintained, especially in groups at greater risk for serious complications from COVID-19. Learn more about vaccines for COVID-19.

How the treatment is done

Treatment of myelitis varies greatly according to each case, but it usually starts with the use of medication to treat possible infections, reduce spinal cord inflammation and relieve symptoms, improving quality of life. Some of the most commonly used medications include:

  • Injectable Corticosteroids, such as Methylprednisolone or Dexamethasone: Rapidly reduce spinal cord inflammation and decrease immune system response, relieving symptoms;
  • Plasma exchange therapy: used in people who have not improved with corticosteroid injection and works by removing excess antibodies that may be causing bone marrow inflammation;
  • Antiviral Medicines: to treat any possible viral infection that is active and damaging the marrow;
  • Analgesics, such as Acetominophen or Naproxen: to relieve muscle pain and any other pain that may arise.

After this initial therapy, and when symptoms are more controlled, the doctor may advise physical therapy sessions to help strengthen muscles and train coordination, which may be affected by the disease. Although physical therapy cannot cure the disease, it can greatly improve muscle strength, coordination of movements, facilitating hygiene and other day-to-day tasks.

In some cases, it may still be necessary to have occupational therapy sessions, so that the person learns to do daily activities with the new limitations that may arise with the disease. But in many cases there is a full recovery in a few weeks or months.

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