Treatments and drugs

By Mayo Clinic Staff

Several 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 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.

  • Antiviral medication. Some people who have a viral infection of the spinal cord may be treated with antiviral medication.
  • Pain medication. Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, including acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

    Nerve pain may be treated with antidepressant drugs, such as sertraline (Zoloft), and anticonvulsant drugs, such as gabapentin (Neurontin, Gralise) or pregabalin (Lyrica).

  • Medications to treat other complications. Your doctor may prescribe other medications as needed to treat problems such as muscle spasticity, urinary or bowel dysfunction, depression, or other complications associated with transverse myelitis.
  • Medications to prevent recurrent attacks of transverse myelitis. People who have positive results for antibodies associated with neuromyelitis optica require ongoing immunosuppressive medications such as corticosteroids to reduce their chances of having recurrent attacks of transverse myelitis or from developing optic neuritis.

Nondrug therapy

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.
  • Psychotherapy. A psychotherapist can use talk therapy to treat anxiety, depression, sexual dysfunction, and other emotional or behavioral issues that may be related to your coping with transverse myelitis.

Prognosis

Although most people with transverse myelitis have at least partial recovery, the process may take a year or more. Most of recovery occurs within the first three months after the episode and strongly depends on the cause of transverse myelitis.

People with neuromyelitis optica have a worse prognosis, although even in this situation, most experience recovery with treatment. About one-third of people with transverse myelitis fall into one 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 have permanent need for a wheelchair and require ongoing assistance with care and everyday activities.

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 do those with relatively slower onset.

Feb. 13, 2014

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