DESCRIPTIONÂ
The immune system is made up of immune cells. Immune cells usually fight off threats from the outside, such as viruses, bacteria, and fungi. In autoimmune diseases, immune cells attack the healthy cells of the body.Â
The nerves of the body are like electrical wires. They have a coating on the outside called myelin. In TM, immune cells attack the myelin coating on the nerves in the spinal cord. Â
The spinal cord connects the brain to the rest of the body. The nerves in the spinal cord bring information about movement from the brain to the body and bring information about sensation from the body to the brain. This means movement and sensation are usually affected by TM. Â
The spinal cord nerves also bring information to and from the gut, the bladder, and the genitals. TM can cause problems with peeing, stooling, or sexual function. Â
The top of the spinal cord (the brain stem) also controls breathing, heart rate, digestion, and blood pressure. TM that affects the brain stem may cause problems with these basic functions.Â
CAUSES
In many cases, TM occurs after an illness. The illness may be a cold with runny nose and cough. It may be a stomach bug with vomiting and diarrhea. We think that a viral infection may trigger the attack. The infection seems to cause the body’s immune system to damage the myelin sheath around nerves in the spinal cord.  Â
TM has been seen in very rare cases after a diagnosis of COVID-19 in both adults and children. TM can also happen after a vaccination, but this is extremely rare.  Â
Sometimes TM can be a part of a disease that might affect the rest of the body, likeÂ
- Neuromyelitis optica (NMO)Â
- Multiple sclerosis (MS)Â
- A rheumatologic disorder, such as systemic lupus erythematosus (SLE) or Sjögren’s syndrome.Â
When no cause for a case of TM is found, it is called idiopathic transverse myelitis. Most cases will be considered idiopathic. Â
Transverse myelitis does not seem to be genetic or run in families. Â
TREATMENT AND THERAPIESÂ Â
Treatments for an Acute Attack
If a child has an attack of TM, a doctor may offer medications that change the way the immune system works. These can include:
- Steroids
- Therapeutic plasma exchange, or plasmapheresis
- Immunoglobulin G, or antibodies from other people, also called IVIG (this is rare)
Other ways to support a patient can include:
Antibiotics and Antivirals
Intubation or feeding tubes
Usually, children will not need long-term treatment to prevent future episodes of TM. Â
Other TreatmentsÂ
Other medications may help with symptoms of TM such as:Â
- Problems with urinationÂ
- ConstipationÂ
- Pain Â
During and after recovery from TM, patients may receive physical therapy to help them improve and regain skills. Â
OUTLOOK
Most recovery happens during the first 3-6 months after the disease starts. Physical therapy can be helpful with this recovery.
Most people with TM will recover fully. Some will continue to have mild weakness or problems with sensation. Rarely, some people have severe lasting weakness or problems with urination after TM.
Usually, TM occurs once and never happens again. If TM does happen more than once, it may mean that there is a problem with the immune system, like neuromyelitis optica (NMO) or multiple sclerosis (MS). A doctor may need to do more testing in this case.
Children with TM may need physical therapy or occupational therapy. This can improve walking and movement.
TM does not affect the way people think or communicate. However, an illness like this can be extremely stressful. Some children may need counseling or therapy during or after their illness.
Resources
Siegel Rare Neuroimmune Association  Â
The Siegel Rare Neuroimmune Association (SRNA) is a not-for-profit international organization dedicated to the support of children, adolescents, and adults with a spectrum of rare neuroimmune disorders, including: Acute Disseminated Encephalomyelitis (ADEM), Acute Flaccid Myelitis (AFM), MOG Antibody Disease (MOGAD), Neuromyelitis Optica Spectrum Disorder (NMOSD), Optic Neuritis (ON) and Transverse Myelitis (TM).   Â
Their mission is to support individuals living with rare neuroimmune diagnoses and their families, promote awareness to empower patients, families, clinicians, and scientists, through education programs (such as the SRNA Quality of Life Family Camp for children and their families diagnosed with a rare neuroimmune disorder) and publications and, to build a collaborative and dedicated clinical care network and help advance scientific understanding and research.  Â
Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF.Â