Transverse Myelitis autoimmune spinal cord disease


Transverse Myelitis is sudden onset inflammation of the spinal cord. It is a autoimmune disorder triggered by viral, bacterial, fungal infections or vaccination and usually treated with IVIg and prednisone.
Transverse Myelitis can happen in MS, Guillian Barre , Borrelia, Lupus and CIDP patients.

Acta Neurol Scand. 2001 Oct;104(4):239-42.

Acute transverse myelitis and Guillain-Barre overlap syndrome with serological evidence for mumps viraemia.

Bajaj NP, Rose P, Clifford-Jones R, Hughes PJ.
Department of Neurology, Hurstwood Park Neurology Centre, Hurstwood Lane, West Sussex, United Kingdom.

Both acute transverse myelitis (ATM) and Guillain-Barre syndrome (GBS) occur as rare associations with mumps viraemia but to our knowledge, concurrent ATM and GBS related to mumps has only been reported once previously. We describe the case of a young woman presenting with confusion and collapse 2 weeks after a flu-like illness. An initial diagnosis of transverse myelitis was made on the basis of the clinical findings and radiological evidence of a swollen spinal cord with uniform high signal change on T2 weighted MRI. The patient was treated with intravenous methylprednisolone without significant recovery. The diagnosis was later revised to include GBS on the basis of worsening facial diplegia in the setting of a flaccid tetraparesis, and neurophysiological evidence of a sensorimotor axonal polyradiculoneuropathy. Acute mumps viraemia was confirmed on serological grounds. The patient made an improvement in ventilatory capacity with intravenous immunoglobulin treatment.
PMID: 11589654 [PubMed - indexed for MEDLINE]

Arq Neuropsiquiatr. 2003 Jun;61(2A):265-8. Epub 2003 Jun 9.

Early-onset acute transverse myelitis following hepatitis B vaccination and respiratory infection: case report.

Fonseca LF, Noce TR, Teixeira ML, Teixeira AL Jr, Lana-Peixoto MA.
Centro Geral de Pediatria, FHEMIG, Belo Horizonte, MG, Brasil.

Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis B vaccination. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis.
PMID: 12806509 [PubMed - indexed for MEDLINE]

Clin Neurol Neurosurg. 2002 Dec;105(1):18-22.

Immunoglobulin-responsive, idiopathic acute transverse myelitis & Elevated 14-3-3 protein and axonal loss

Finsterer J, Voigtlander T.

OBJECTIVES: To report the elevation of the 14-3-3 protein and the complete denervation of hand muscles in idiopathic acute transverse myelitis (IATM) of the cervical cord. CASE DESCRIPTION: In a 29-year-old woman with a 2-week history of neck pain and repeated attenuated flus, subacute quadriplegia, hypaesthesia of both arms, a T3 sensory level, and urinary dysfunction occurred. Based upon the clinical findings, the cervical MRIs, and an elevated 14-3-3 protein in the CSF, IATM C4-C7 was diagnosed. Ten, 17, 28 and 61 days after onset, nerve conduction studies revealed complete denervation of the right abductor pollicis brevis and abductor digiti minimi muscles but gradual improvement of the compound muscle action potential of the left abductor pollicis brevis muscle. F-waves of the right median nerve were absent. Tibial somatosensory evoked potentials showed a prolonged central conduction time. Transcranial magnetic stimulation evoked a response in the left but not the right abductor digiti minimi muscle. CONCLUSION: IATM may cause elevation of the 14-3-3 protein and loss of motor axons originating from affected anterior horn cells.
PMID: 12445918 [PubMed - indexed for MEDLINE]

Can J Neurol Sci. 2004 May;31(2):265-7.

Devic's neuromyelitis optica treated with intravenous gamma globulin (IVIG).

Bakker J, Metz L.
Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.

BACKGROUND: Devic's syndrome is a demyelinating disease of the spinal cord and optic nerves. It tends to have a poor prognosis, probably due to the occurrence of necrosis within lesions. There is no proven effective treatment although relapses are commonly treated with corticosteroids and people with recurrent attacks may be managed with chronic immune suppressing treatments. Intravenous gamma globulin (IVIG) and plasma exchange are reasonable treatment options because Devic's syndrome is believed to be antibody mediated. We report two patients of Devic's syndrome that stabilized following initiation of monthly IVIG. PATIENT 1: A 42-year-old woman with a 23 year history of Devic's syndrome continued to have frequent attacks of optic neuritis unresponsive to daily corticosteroids and azathioprine. Since initiation of monthly IVIG 5 1/2 years ago she has had no further definite attacks. She has also noted minimal improvement in color perception. PATIENT 2: A 58-year-old woman with a three year history of Devic's syndrome experienced five attacks during the first 16 months of disease. Monthly IVIG was associated with complete cessation of relapses and significantly improved neurological status over one year of treatment. CONCLUSIONS: Because active Devic's disease often results in severe, permanent neurological impairment, preventive intervention should be considered. These cases suggest that IVIG may be effective in preventing attacks and possibly in enhancing neurological recovery. Randomized controlled trials will be needed to confirm this and to determine optimal dosing and treatment duration.
PMID: 15198456 [PubMed - indexed for MEDLINE]

Conn Med. 1998 Jul;62(7):387-90.

Acute transverse myelitis in systemic lupus erythematosus: a case of rapid diagnosis and complete recovery.

Habr F, Wu B.
Department of Medicine, Hospital of Saint Raphael, New Haven, USA.

Acute transverse myelitis is a rare and serious complication of systemic lupus erythematosus. Delay in diagnosis and treatment is associated with significant morbidity and mortality. Earlier diagnosis is facilitated by magnetic resonance imaging. Treatment of systemic lupus erythematosus-related acute transverse myelitis remains controversial. The use of steroids alone may result in incomplete recovery. We report a patient who was promptly diagnosed with systemic lupus erythematosus-related acute transverse myelitis by magnetic resonance imaging. The patient had complete resolution of her symptoms following aggressive treatment with steroids and cyclophosphamide. Review of published treatment of systemic lupus erythematosus-related acute transverse myelitis suggests aggressive therapy with steroids and cyclophosphamide may provide the best outcome.
PMID: 9707792 [PubMed - indexed for MEDLINE]

J Neurol Sci. 2004 Dec 15;227(1):39-47.

Effect of immunotherapy in myelitis with atopic diathesis.

Murai H, Arahata H, Osoegawa M, Ochi H, Minohara M, Taniwaki T, Tobimatsu S, Mihara F, Tsuruta Y, Inaba S, Kira J.
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.

OBJECTIVE: A recent nationwide survey of myelitis with atopic diathesis in Japan disclosed that the disease frequently shows a chronic persistent course. A neuropathological study of the spinal cord also revealed chronic active inflammation. Since the effects of various immunotherapies have not been studied extensively in this condition, we evaluated the efficacies of various immunotherapies in patients with myelitis with atopic diathesis. PATIENTS AND METHODS: Forty-two treatments in 26 patients with myelitis with atopic diathesis were retrospectively analyzed. One of the following therapies was administered: (1) corticosteroids (CS) (pulse therapy followed by oral administration with gradual tapering); (2) intravenous immunoglobulin (IVIG) (400 mg/kg/day for 5 consecutive days); (3) plasma exchanges (PE); or (4) PE followed by IVIG or CS (PE+IVIG/CS). The therapeutic efficacies were evaluated by thorough neurological examination and laboratory tests including MRI, somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs).
RESULTS: Objective neurological findings improved in 89% of the PE group and 90% of the PE+IVIG/CS group, compared with only 72% of the CS and 60% of the IVIG groups. Improvement determined by laboratory tests was seen in 57% of the PE and 57% of the PE+IVIG/CS groups, compared with only 15% of the CS and none of the IVIG groups. Thus, the improvement rate determined by laboratory tests was significantly greater for therapies including PE than for those without PE (p=0.0187). CONCLUSIONS: These data suggest that immunotherapy is effective in myelitis with atopic diathesis despite a chronic persistent course, and that PE is the most beneficial immunotherapy.

This last study shows that plasmapheresis and IVIg combination is very effective for treatment of Myelitis (inflammation of spinal cord). Improvement seen in 90% of the group.

 If you cannot get IVIg use Omega-3 fatty acids, use Vitamin-D and Turmeric  read our diet chapter. Great benefit will be seen from electronic stimulation
in the central nervous system