At the OHSU Multiple Sclerosis Center, you’ll find the expertise you need for transverse myelitis. Our specialists work in teams to diagnose and treat this complex condition.

We offer:

• A team with the experience to accurately diagnose transverse myelitis.
• Advanced technology to test for the disease and rule out other causes of your symptoms.
• Providers who understand the different forms of transverse myelitis and the most effective treatments.
• Rehabilitation experts to help you recover from a transverse myelitis attack.
• Providers who are also researchers gaining new understanding of nerve disorders.

What is transverse myelitis?

Transverse myelitis is a rare disorder that inflames the spinal cord. Transverse means it affects both sides of the same section of spinal cord.

The swelling damages myelin, the sheath that covers and protects nerve fibers. That disrupts nerve signals from the spinal cord to the body. The result can be weakness, paralysis and other symptoms below the inflammation.

Transverse myelitis can occur on its own or as part of another disorder, such as neuromyelitis optica spectrum disorder (NMOSD). It can also signal a risk of developing multiple sclerosis.

Who gets transverse myelitis?

About 1,400 new cases of transverse myelitis are diagnosed each year in the United States. About 33,000 Americans have a disability related to a transverse myelitis attack. Some patients have only one attack (monophasic transverse myelitis) but can still have long-term issues.

The disorder can affect anyone, but experts have identified  patterns:

• Gender: Women are at higher risk.
• Age: It most often affects people ages 10 to 19 and 30 to 39.
• Family history: Transverse myelitis does not appear to run in families or to be linked to a genetic defect.

What causes transverse myelitis?

About half the time, transverse myelitis follows an infection. In some other cases, the cause is unknown (idiopathic). Causes include:

• Viral infections such as the flu, tuberculosis, HIV, herpes simplex and varicella zoster (the virus that causes chicken pox).
• Bacterial infections, including middle-ear infections and bacterial pneumonia.
• Some cancers — most often lung, ovarian, lymphatic or breast cancer. In rare cases, cancer can trigger an autoimmune response, when the immune system attacks the body’s own tissues.
• Underlying immune system disorders, including multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD).
• Other inflammatory disorders that affect the spinal cord.

Transverse myelitis and multiple sclerosis

In a minority of cases, transverse myelitis can be an early symptom of multiple sclerosis, which also involves myelin damage.

If your doctor suspects MS, you may have an MRI (magnetic resonance imaging) scan. If the MRI shows more than two lesions (damaged areas) on the spinal cord, there's a high chance of developing MS.

Transverse myelitis recovery

Most patients recover within three months of the attack, though others may need two years or longer. Most also recover at least partially. Some may have a slight, moderate or severe disability, from trouble walking to needing a wheelchair and help with daily activities.

Recovery often depends on the cause of transverse myelitis and how suddenly it came on. Attacks linked to neuromyelitis optica spectrum disorder or rapid onset tend to have less chance of a full recovery.

Symptoms of transverse myelitis

Symptoms can develop over hours, days or gradually over several weeks. Symptoms depend on the part of the spinal cord where damage occurs.

Damage at a certain segment will affect bodily functions at that level and below. If the damaged segment is lower on the spine, for example, the function and feelings in the upper body might not be affected. If the damage is higher, most of the body will be affected.

Symptoms include:

• Pain, especially in the lower back
• Unusual sensitivity to touch and temperature
• A banding or girdle-like sensation around the torso
• Numbness or tingling in the legs
• Weakness or paralysis in the arms and/or legs
• Bowel and bladder problems
• Fatigue
• Sexual dysfunction
• Depression

Types of transverse myelitis

• Partial transverse myelitis: In this type, inflammation is patchy or extends across only part of a spinal cord section. Symptoms may be different on each side of the body. Vertically, the lesion spans no more than three vertebrae.
• Complete transverse myelitis: In this type, inflammation covers the full width of the spinal cord section. Symptoms are similar on both sides of the body. Patients often lose most or all function below the lesion. Vertically, the lesion spans no more than three vertebrae
• Longitudinally extensive transverse myelitis: The lesion in this type extends vertically across more than three vertebrae. Patients often have at least partial paralysis of their legs, or their legs and arms. Many also have bowel and bladder problems.

Diagnosing transverse myelitis

At OHSU, your team will include expert neurologists, radiologists and rehabilitation specialists, among others. Our team-based approach means you can expect a precise diagnosis and a treatment plan tailored to your needs.

There is no single test for transverse myelitis. Our diagnostic process includes:

• Medical history: Your doctor will ask about symptoms and recent history of infection.
• A neurologic exam: The doctor will check thinking, balance, reflexes and movement to see how your nervous system is working.
• Imaging: MRI scans of your brain and spinal cord can show lesions from transverse myelitis, or they can point to another cause of your symptoms.
• Spinal tap (lumbar puncture): This test withdraws a small amount of fluid from the canal next to your spinal cord to look for signs of infection or a disorder.
• Blood tests: Your team will look for substances called antibodies that are present in some types of transverse myelitis. They can also look for evidence of infections that can trigger the disorder, helping guide treatment. Blood tests can also help us spot or rule out another cause of your symptoms.

Treatment for transverse myelitis

There is no cure for transverse myelitis, but treatments can address infections, reduce inflammation and manage symptoms. At OHSU, our treatments include:

Anti-inflammatory medications: Taking medications to reduce inflammation is usually the first treatment. Patients often have a course of IV corticosteroids followed by oral steroids.

Plasma exchange therapy (PLEX): This treatment is an option for people who don't respond well to corticosteroids. In PLEX, the liquid part of your blood (plasma) is separated from your blood cells and replaced with artificial plasma. This removes the substances, such as harmful antibodies or proteins, that may cause inflammation.

Immunosuppression medications: If inflammation persists, you may receive a chemotherapy drug called cyclophosphamide or other medications. These can change the way your immune system reacts to transverse myelitis. Your doctor will closely watch for potential complications.

Intravenous immunoglobulin (IVIG): With this treatment, you receive a concentrated injection of antibodies in plasma from healthy donors. The new antibodies disable antibodies in your body that may be causing the problem.

Other medications: Your doctors may suggest pain medicines, muscle relaxants or antidepressants to ease other symptoms.

Rehabilitation therapy: We offer rehabilitation experts who are specially trained in treating patients with nerve disorders. Options include:

• Physical therapy to help retain muscle strength and improve coordination.
• Occupational therapy to help people with paralysis become as fully functional as possible.
• Psychotherapy to cope with stress, depression and other emotions that may arise from a disabling condition.

Pain management: The OHSU Comprehensive Pain Center offers treatment for short- and long-term pain. Our team can also help you address the physical, mental and behavioral issues that can result from ongoing pain.

Learn more

• OHSU research on MS and related disorders
• Transverse Myelitis, National Multiple Sclerosis Society
• Transverse Myelitis, National Organization for Rare Disorders