Transverse myelitis (TM) in children

What is transverse myelitis (TM) in children?

Transverse myelitis is inflammation of the spinal cord, which is normally responsible for communication between the brain and the body. The inflammation can damage the covering around nerve cells (myelin) in the spinal cord and can damage the nerve cells themselves. This damage interrupts the messages that nerves in the spinal cord send to other parts of the body, which can affect a child’s ability to move or feel.

When a child has transverse myelitis, their immune system has damaged the covering around nerve cells (myelin). Transverse refers to the pattern of changes of sensation that a child may feel, including a band of sensation across the middle of the body.

Transverse myelitis can be triggered by a viral, bacterial or fungal infection. It also can be caused by an autoimmune response following an infection, which means that the immune system starts reacting against the body rather than against the infection itself. Sometimes transverse myelitis occurs in the setting of other rare pediatric conditions such as multiple sclerosis, neuromyelitis optica or anti-MOG associated disorder.

Most people recover at least partially, although the recovery may take more than a year. Some people have few symptoms afterwards. Others may have moderate or severe disabilities. How well a child does depend on what caused the condition, how early the child was treated and the rehabilitation that a child pursues.

What are the different types of transverse myelitis (TM) in children?

There are different patterns of transverse myelitis that vary by what part of the spinal cord is affected, how large the affected area is, and what kind of damage it causes.

• Upper motor neuron damage - This pattern of transverse myelitis affects tissue in the spinal cord called white matter. It can cause muscles to tighten after the initial period of weakness.

• Lower motor neuron damage - This pattern of transverse myelitis affects the tissue in the spinal cord called gray matter. It can cause the affected limbs and muscles to be floppy rather than tight. This is the pattern seen in acute flaccid myelitis (AFM).

What are the signs and symptoms of transverse myelitis (TM) in children?

TM usually involves muscle weakness or paralysis, and children usually have some problems urinating – a symptom that can appear early.

In general, signs and symptoms include:

• Weakness

• Numbness (loss of sensation)

• Difficulty controlling bowel or bladder functions

• Inability to urinate or empty the bladder

• Difficulty walking

• Problems with balance

How is transverse myelitis (TM) in children diagnosed?

The doctor will take a medical history and do a physical exam of your child.

They may then do the following tests:

• MRI of the spinal cord, which can determine whether a child has acute flaccid myelitis or another condition. The MRI is particularly important in determining whether a child has transverse myelitis or another condition.

• Testing of the spinal fluid for levels of white blood cells or other indicators of inflammation

• Testing of a nose (nasopharyngeal) swab, because the virus can be found in the nose and not in spinal fluid.

• Testing of stool specimens or rectal swabs to check for viral infections

• Blood tests to look for certain autoimmune conditions

What causes transverse myelitis (TM) in children?

This neurological disorder can have three kinds of causes:

1. Its causes may be unknown (this is called idiopathic). Most of these are believed to happen when the immune system causes damage after an infection.

2. It may be caused by an autoimmune disorder. The most common autoimmune disorders that can trigger transverse myelitis in children are multiple sclerosis, neuromyelitis optica (which affects the spinal cord and eyes) and anti-MOG associated disorder (which attacks a particular type of protein).

3. It may be triggered by an infection of the spinal cord. When the immune system responds to the infection, it triggers transverse myelitis. An example is acute flaccid myelitis, a very rare, polio-like condition.

How is transverse myelitis (TM) in children treated?

• Steroids - If your child has transverse myelitis, we will first treat them to limit the inflammation in their spinal cord, such as with high doses of steroids.

• Plasma exchange therapy - We may also use plasma exchange therapy (plasmapheresis or PLEX), which replaces the plasma in the blood with other fluids.

• Intravenous immune globulin (IVIG) - We may use intravenous immune globulin (IVIG), which is made up of blood proteins (antibodies) that help fight infections.

• Managing symptoms - Next, we will work with them to manage their symptoms, which can mean helping manage nerve pain, problems with urinary or bowel function, or other complications.

• Rehabiliation - Finally, we do rehabilitation to help with long-term care and recovery.

  • Physical therapy (PT) - Your child may benefit from physical therapy (PT), to help them improve their coordination and strength.

  • Occupational therapy (OT) - An occupational therapist (OT) can also work with your child if they need to learn new ways to do daily activities, such as bathing or getting dressed.

It’s important to start these therapies early.