Drs. Levy and Klawiter
Drs. Levy and Klawiter discuss a patient's brain scan.

Transverse myelitis (TM) is sometimes a symptom of NMOSD or MOG, but it can also be its own diagnosis.

Transverse myelitis is an inflammatory attack of the spinal cord characterized by destruction of the insulating material, or myelin, surrounding the nerve cells. The symptoms of TM include a sensation of tightness across the trunk of the body and other sensory changes, including but not limited to weakness of arms and/or legs, back and/or limb pain, numbness, tingling, burning or coldness, and paralysis. Sometimes, TM attacks the autonomic (involuntary) functions of the nervous system, such as breathing, the heart, and reflexes. The symptoms can come on either gradually or suddenly but most commonly present between 4 hours and 21 days.

Idiopathic transverse myelitis is the term designated to the monophasic (single attack) form. Idiopathic TM is thought to be an autoimmune condition that follows an infection when the immune system surveilling the spinal cord misidentifies a self-protein as a foreign protein and attacks it. TM may also occur as part of a relapsing disease such as multiple sclerosis, neuromyelitis optica, MOG antibody disease, ADEM and neurosarcoidosis.

Whatever the cause, acute attacks of TM can be treated with corticosteroids, plasmapheresis (removal and replacement of the plasma from a patient’s blood) or IVIG (intravenous immunoglobulin) in which immunoglobulins from donors are infused into the bloodstream.

The term “acute transverse myelitis” was first coined by an English neurologist in 1948 referring to progressive paralysis of the lower limbs. In 2002, The Transverse Myelitis Working Group established diagnostic criteria in order to create a clear distinction between what was already being called Transverse Myelitis and non-inflammatory diseases of the spinal cord. The most common non-inflammatory cause of spinal cord disease is vascular myelopathy in which blood flow into or out of the spinal cord is disrupted.