The American Academy of Neurology has released its new evidence-based clinical guidelines for the treatment of transverse myelitis. The guidelines were drafted after an intensive review of relevant articles published between 1966 and 2009.
Transverse myelitis is a neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. The term myelitis refers to inflammation of the spinal cord; transverse simply describes the position of the inflammation, that is, across the width of the spinal cord. Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. This damage causes nervous system scars that interrupt communications between the nerves in the spinal cord and the rest of the body.

Symptoms of transverse myelitis include a loss of spinal cord function over several hours to several weeks. What usually begins as a sudden onset of lower back pain, muscle weakness, or abnormal sensations in the toes and feet can rapidly progress to more severe symptoms, including paralysis, urinary retention, and loss of bowel control. Although some patients recover from transverse myelitis with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Most patients will have only one episode of transverse myelitis; a small percentage may have a recurrence.

According to the National Institute of Health’s National Institute of Neurological Disorders and Stroke (NINDS), about one-third of people affected with transverse myelitis experience good or full recovery from their symptoms; they regain the ability to walk normally and experience minimal urinary or bowel effects and paresthesias. Another one-third show only fair recovery and are left with significant deficits such as spastic gait, sensory dysfunction, and prominent urinary urgency or incontinence. The remaining one-third show no recovery at all, remaining paralyzed with marked dependence on others for basic functions of daily living. Unfortunately, making predictions about individual cases is difficult.

A summary of the new guidelines includes:

• Therapies are available that may help treat acute TM.
o Plasma exchange (PE) may help treat people with TM who are not helped by steroid therapy.

• Testing for an autoimmune response to aquaporin-4, a protein found in the nervous system, can help confirm acute TM caused by neuromyelitis optica (NMO)
o This testing can also help predict risk of a TM relapse.

• More and better research is needed on therapies for TM.
o Higher-quality studies on therapies should be pursued.

Sources:

AAN Summary of Evidence-Based Guidelines for Clinicians: Plasmapheresis in Neurologic Disorders
http://www.aan.com/practice/guideline/uploads/471.pdf

AAN Summary of Evidence-Based Guidelines for Patients and Their Families: Using Plasma Exchange to Treat Neurologic Conditions
http://www.aan.com/practice/guideline/uploads/472.pdf

To read more about living with TM, see Kim Harrison’s story in the Reeve Foundation's community: http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.6357597/k.3480/Living_Life_to_the_Fullest_with_TM.htm

Transverse Myelitis Association : http://www.myelitis.org/