Acute transverse myelitis

Acute transverse myelitis (ATM) is an inflammatory neurological disorder characterized by acute or subacute inflammation across both sides of one or more segments of the spinal cord. The term 'transverse' refers to the inflammation extending across the width of the spinal cord. This condition disrupts the normal transmission of nerve signals along the spinal cord, affecting motor, sensory, and autonomic function below the level of the lesion. It can occur as an isolated idiopathic condition or in association with other disorders such as multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), systemic autoimmune diseases (e.g., systemic lupus erythematosus, sarcoidosis), or following infections and vaccinations. Key symptoms typically develop rapidly over hours to days and include bilateral (though sometimes asymmetric) weakness or paralysis of the legs and sometimes the arms depending on the spinal cord level affected, sensory disturbances such as pain, numbness, tingling, and a band-like sensation around the trunk, as well as bowel and bladder dysfunction. Patients may also experience back pain at the level of inflammation. The severity varies widely, ranging from mild sensory symptoms to complete paraplegia with loss of bladder and bowel control. Treatment focuses on reducing spinal cord inflammation and managing symptoms. First-line therapy typically involves high-dose intravenous corticosteroids (such as methylprednisolone). For patients who do not respond adequately to steroids, plasma exchange (plasmapheresis) may be considered. Intravenous immunoglobulin (IVIG) has also been used in some cases. Long-term rehabilitation, including physical therapy, occupational therapy, and management of pain, spasticity, and bladder dysfunction, is essential. Approximately one-third of patients recover well, one-third have moderate residual disability, and one-third experience severe permanent neurological deficits. Identifying an underlying cause is important, as conditions like NMOSD or multiple sclerosis may require specific long-term immunotherapy to prevent recurrence.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

Common questions about Acute transverse myelitis