Treatment

Several therapies target the acute signs and symptoms of transverse myelitis:

  • Intravenous steroids. You'll probably 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 need plasma exchange therapy. This 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 inflammatory antibodies.

  • Antiviral medication. Some people who have a viral infection of the spinal cord may be treated with medications to treat the virus.
  • Pain medication. Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, such as 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 antibodies associated with neuromyelitis optica need ongoing medications, such as corticosteroids and/or immunosuppressants, to reduce their chances of more transverse myelitis attacks or developing optic neuritis.

Other therapies

Additional therapies focus on long-term recovery and care:

  • Physical therapy. This helps improve strength and coordination. Your physical therapist can teach you how to use any needed assistive devices, such as a wheelchair, canes or braces.
  • Occupational therapy. This 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 from coping with transverse myelitis.

Prognosis

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

About one-third of people with transverse myelitis fall into one of three categories after an attack:

  • No or slight disability. These people experience only minimal lingering 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 permanently need a wheelchair and require ongoing assistance with daily care and 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 a relatively slower onset.

Nov. 12, 2016
References
  1. Transverse myelitis fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/transversemyelitis/detail_transversemyelitis.htm. Accessed Aug. 23, 2016.
  2. Transverse myelitis. The Transverse Myelitis Association. http://myelitis.org/symptoms-conditions/transverse-myelitis/. Accessed Aug. 23, 2016.
  3. Eisen A. Disorders affecting the spinal cord. http://www.uptodate.com/home. Accessed Aug. 23, 2016.
  4. Krishnan C, et al. Transverse myelitis. http://www.uptodate.com/home. Accessed Aug. 23, 2016.
  5. Weinshenker BG (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 28, 2016.
  6. Frohman E, et al. Transverse myelitis. The New England Journal of Medicine. 2010; 363:564.
  7. Wingerchuk  D, et al. Acute disseminated encephalomyelitis, transverse myelitis, and neuromyelitis optica. Continuum. 2013;19(4):944.
  8. Scott T, et al. Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis. Neurology. 2011;77:2128.