Transverse myelitis

• Disease Description (Causes and Symptoms)

  • Definition summary: Transverse myelitis is a disease in which acute inflammation develops in the spinal cord, causing impairment of sensory, motor, and autonomic function at a specific horizontal level. Causes vary and include post-infectious immune responses, autoimmune diseases (e.g., multiple sclerosis (MS) and anti-AQP4/anti-MOG-related neuritis), and blood-flow disorders.
  • Pathophysiology overview: When inflammation damages spinal cord nerve fibers and myelin, conduction impairment occurs along the affected neural pathways, causing acute sensory abnormalities, motor weakness, and bladder and bowel dysfunction.
  • Main symptoms: Acute/subacute weakness or paralysis of the legs, decreased sensation (possibly band-like sensory disturbances), urinary and bladder dysfunction, urinary incontinence or bowel dysfunction, spinal pain or radiating pain, muscle stiffness/hypertonia, sensations of heat or tingling, and more. Symptoms may worsen over several hours to several days.

• Treatment Methods and Precautions (Treatment · Risk of Complications · Self-Management)

  • Standard treatment in the acute phase
    • High-dose intravenous steroids (e.g., methylprednisolone 1 g/day IV, usually for 3–5 days) — recommended as initial treatment.
    • If unresponsive to steroids, plasmapheresis (plasma exchange) may be considered (usually 5–7 exchanges).
    • IVIG (intravenous immunoglobulin) may be used in some cases, depending on the case and circumstances.
  • In recurrent or autoimmune-related cases
    • If an underlying disease (such as AQP4-positive NMO) is identified, long-term immunosuppressive therapy (e.g., rituximab, azathioprine, mycophenolate, etc.) may be considered.
  • Symptom and complication management
    • Pain control (medications for neuropathic pain, such as gabapentin, pregabalin, and tricyclic antidepressants), treatment of muscle stiffness (oral medications, Botox, etc.), DVT prevention (especially in cases of paraplegia), pressure-ulcer prevention, and bladder and bowel rehabilitation (catheterization and bowel management).
    • Physical and occupational therapy (continuous rehabilitation from the early stage is important for prognosis).
  • Precautions
    • Early diagnosis and immediate treatment are decisive for prognosis.
    • Increased risk of infection during immunosuppressive treatment — check vaccination history and avoid live vaccines.
    • Long-term management of urinary, bowel, and sexual function and psychosocial problems is necessary.
  • Risk of complications
    • Possibility of permanent motor impairment (partial or complete paralysis), chronic pain, urinary tract infections and kidney complications (due to bladder dysfunction), pressure ulcers, thrombophlebitis, and conversion to a neuroimmunological disease (MS or NMO).

• Checklist Before an Outpatient Visit (Items to Bring · Records · Information)

  • Items to bring
    • A list of all medications currently being taken (including prescription drugs, OTC medicines, and supplements), along with doses and administration times.
    • Copies or a CD of previous test results (MRI, neurological examination findings, lumbar puncture (CSF) results, etc.).
    • A record of recent symptom changes: time of onset, rate of worsening, distribution of symptoms (e.g., which area was affected first), changes in urination and bowel movements, and the nature of the pain.
    • History of previous infections (recent viral illnesses and vaccination history), history of autoimmune diseases, and family history.
    • Mobility aids (if needed) and photos of immediately concerning symptoms (e.g., areas suspected to be pressure ulcers).
  • Key information to share with the doctor during the outpatient visit
    • The time of symptom onset and course (whether sudden or gradual), systemic symptoms (such as fever), and whether similar neurological symptoms have occurred before.

• Examples of General Questions to Ask the Doctor

  • What are the expected effects and major side effects of this medication (steroids or immunosuppressants)?
  • What is my prognosis (likelihood of recovery), and how long does recovery usually take?
  • When should rehabilitation (physical and occupational therapy) begin, and how often should I receive it?
  • What vaccinations or preventive measures should I take to prevent infections?
  • What is the risk of recurrence, and what treatment would be expected if it recurs?

• Examples of Disease-Specific Questions

  • Should I be tested for AQP4 (anti-aquaporin antibody) or MOG antibodies? How would the long-term treatment plan change depending on the test results?
  • If there is no improvement after steroid treatment, when would plasmapheresis or IVIG be attempted? What would be the expected treatment sequence and criteria?

(If necessary, diagnostic tests: spinal cord MRI (to identify the location and extent of inflammation), lumbar puncture (CSF testing to identify inflammatory markers, infectious agents, and immune markers), and blood tests (including infection and autoimmune antibodies such as AQP4 and MOG).)