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Treatments and drugs
By Mayo Clinic staffSeveral therapies target the acute signs and symptoms of transverse myelitis:
- Intravenous steroids. After your diagnosis, you'll likely receive steroids through a vein in your arm over the course of several days. Steroids help reduce the inflammation in your spinal column.
- Plasma exchange therapy. People who don't respond to intravenous steroids may undergo plasma exchange therapy. This therapy involves removing the straw-colored fluid in which blood cells are suspended (plasma) and replacing the plasma loss with special fluids. It's not certain how this therapy helps people with transverse myelitis, but it may be that plasma exchange removes antibodies that are involved in inflammation.
- Pain medication. Chronic pain is a common complication of transverse myelitis. Nonsteroidal anti-inflammatory drugs — such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others) — can help reduce inflammation and relieve pain.
Other therapies focus on long-term recovery and care:
- Physical therapy. Physical therapy helps you increase strength and improve coordination. Your physical therapist will likely teach you how to use assistive devices, such as a wheelchair, canes or braces, if needed.
- Occupational therapy. This type of therapy helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
- Other medications. Your doctor may make suggestions for long-term treatment depending on any complications that you may be experiencing. For example, if you're plagued by painful muscle spasms, your doctor may recommend anti-spasticity drugs. Or if you think you may be depressed, taking antidepressant medication may help. Treatment can be tailored to fit your needs.
Prognosis
Although most people with transverse myelitis have at least partial recovery, the process may take up to two years. About one-third of people with transverse myelitis fall into each of three categories after an episode of transverse myelitis:
- No or slight disability. These people experience only minimal residual symptoms.
- Moderate disability. These people are mobile, but may have difficulty walking, numbness or tingling, and bladder and bowel problems.
- Severe disability. Some people may remain wheelchair-bound and dependent on others for help with daily tasks.
It's difficult to predict the course of transverse myelitis. Generally, people who experience a rapid onset of signs and symptoms have a worse prognosis than those with relatively slower onset.
- Transverse myelitis fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm. Accessed Nov. 1, 2008.
- Eisen A. Disorders affecting the spinal cord. http://www.uptodate.com/home/index.html. Accessed Nov. 1, 2008.
- Kerr D. Transverse myelitis. In: Johnson RT, et al. Current Therapy in Neurologic Disease. 6th ed. Philadelphia, Pa.: C.V. Mosby; 2001. http://www.scribd.com/doc/2581918/KerrCurrent-therapy-chapter-with-figures. Accessed Nov. 1, 2008.
- Petti CA. Molecular diagnosis of central nervous system infections. http://www.uptodate.com/home/index.html. Accessed Nov. 1, 2008.
- Acute transverse myelitis. The Merck Manuals Online Medical Library: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec16/ch224/ch224b.html. Accessed Nov. 1, 2008.
- Weinshenker BG, et al. Neuromyelitis optica IgG predicts relapse following longitudinally extensive transverse myelitis. Annals of Neurology: 2006;59:566.
- Jacob A, et al. An approach to the diagnosis of acute transverse myelitis. Seminars in Neurology. 2008; 28(1):105.
- Weinshenker BG [expert opinion]. Mayo Clinic, Rochester, Minn. Oct 6, 2008.
