Transverse Myelitis and Autoimmunity

 Transverse Myelitis and Vaccine-Induced Autoimmunity

  • Transverse Myelitis (TM) is a neurological disorder that damages the substance that surrounds and insulates nerves called myelin.
  • Inflammation initiated by infections, vaccinations, and other immunity or vascular disorders causes TM.
  • There is no cure for TM, but many therapies exist to treat the underlying causes of TM as well as rehabilitate individuals’ quality of life.

Vaccine injury compensation programs exist because disease poses financial as well as physical stress on people. Transverse myelitis is an example of a disease that requires extensive treatment and extended rehabilitation. So, seeking compensation with the help of a vaccine law firm when a disease is caused by a vaccine can be a great help during an already difficult time.

This article covers the following topics to provide an informative overview of Transverse Myelitis:

  • What is Transverse Myelitis?
  • Causes of Transverse Myelitis and its Risk Factors
  • Challenges of Living with Transverse Myelitis
  • How Transverse Myelitis Is Treated

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What is Transverse Myelitis?

Transverse Myelitis, or TM, is an inflammatory, neurological disease. This disorder arises from one section of the spinal cord becoming inflamed. With only one section of the spinal cord affected, TM often produces a loss of sensation across a specific area of the upper body just below the site of inflammatory. “Transverse” describes the affected area forming a band-like pattern whereas “myelitis” describes where this disease causes the most damage.

The nerves of the spinal cord extend outward and course through body tissues to carry out their many functions. In order to ensure efficient communication between the brain and tissues via the nerves, nerves are insulated with a fatty substance called myelin. Well, TM actually deteriorates myelin thereby eliminating nerves’ insulation. As a result, the relay of information between the brain and tissues is interrupted and severely compromised leading to a host of neurological symptoms.

Causes of Transverse Myelitis and its Risk Factors

It is possible for transverse myelitis to arise on its own without cause aside from excessive immune system activity that induces inflammation and myelin damage. This form of TM is called idiopathic transverse myelitis. Infections, disorders of the immune system, and any inflammatory or vascular disorder that damages myelin can cause TM. These include:

  • Bacterial infections, such as actinomyces, Lyme disease, pertussis, tetanus, diphtheria, syphilis, tuberculosis, campylobacter jejuni gastroenteritis, mycoplasma bacterial pneumonia, and even infections of the skin or middle-ear.

 

  • Fungal infections that can invade the spinal cord like Aspergillus, Blastomyces, Coccidioides, and Cryptococcus.

 

  • Parasitical infections with Angtiostrongyloides, Cysticercosis, Shistosomiasis, and Toxoplasmosis.

 

  • Viral infections like herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus, West Nile virus, Zika virus, influenza, echovirus, hepatitis B, mumps, measles, and rubella.

 

  • Immune system disorders, like autoimmunity, multiple sclerosis, neuromyelitis optica, and an abnormal, underlying cancer response.

 

  • Inflammatory disorders which consist of Bechet’s syndrome, lupus, mixed connective tissue disease, sarcoidosis, scleroderma, and Sjogren’s syndrome.

 

  • Vascular disorders, namely arteriovenous malformation, disk embolism, dural arterial-venous fistula, and intraspinal cavernous malformations.

The autoimmunity mentioned above can be triggered by vaccinations, specifically vaccinations for influenza and Hepatitis B boosters, and within six weeks of the vaccination. In one unique case, Transverse Myelitis and Guillain-Barre’ Syndrome developed overlapping symptoms following Tdap vaccination. Studies show that TM can also arise as a symptom of multiple sclerosis. Vascular disorders cause TM indirectly by restricting blood flow to the spinal cord as opposed to triggering inflammation. Consequently, this imposes stroke-like effects on the spinal cord.

Diagnosing Transverse Myelitis begins with a medical professional getting a full medical history and conducting a neurological physical examination. Evaluating the spinal cord in this manner allows other conditions, like trauma, herniated discs, stenosis, abscesses, or vitamin deficiencies, to be ruled out. Subsequent diagnostic tests consisting of magnetic resonance imaging (MRI), computed tomography (CT), lumbar puncture (sometimes called a spinal tap), and blood tests are administered to not only confirm the TM diagnosis, but also its cause. The MRI and CT can reveal inflammation whereas the lumbar puncture and blood tests will reveal the presence of an infection, immune system disorder, or vascular disorder.

Challenges of Living with Transverse Myelitis

A notable sign of TM is that any of the symptoms listed below may develop relatively quickly in a matter of hours or longer periods of time, such as days and weeks. The overall decline in function of the nervous system typically lasts 4 to 21 days. However, the majority of cases (80 percent) experience their greatest point of decline at 10 days.

Symptoms of transverse myelitis include:

  • Anxiety
  • Bowel incontinence
  • Breathing issues
  • Burning sensations (also known as paresthesias)
  • Constipation
  • Depression
  • Difficulty urinating or passing bowels
  • Fatigue
  • Fever
  • Headache
  • Loss of appetite
  • Muscle spasms
  • Numbness
  • Pain or discomfort
  • Progressive paralysis
  • Sensory loss to pain and temperature
  • Sexual dysfunction
  • Tingling
  • Urgency to urinate
  • Urinary incontinence
  • Weakness in the extremities, but usually the legs

For half of individuals diagnosed with TM, the greatest point of decline is total paralysis in both legs. Loss of sensation below a band of the upper body, burning sensations, and numbness make up the symptoms that 80 to 94 percent of people with TM experience whereas practically everyone diagnosed with TM has some issue with their bladder.

Transverse Myelitis affects all genders, ages, and races. While research has yet to determine a genetic or hereditary predisposition for TM, new cases of TM do seem to spike among two specific age groups: 10 to 19 years of age and 30 to 39 years of age. In the United States alone, around 1,400 new cases of TM are diagnosed annually.

How Transverse Myelitis Is Treated

Unfortunately, full recovery from TM is rare, as even minor symptoms usually remain after treatment and TM often recurs in diagnosed individuals. Following treatment, about one-third of individuals recover with minor symptoms, another third recovers with a moderate disability, and the final third recovers with a severe disability. Despite the outcome, recovery time lasts anywhere from months to years.

Treatments for transverse myelitis vary, but mainly aim to address the cause of TM. For instance:

  • Corticosteroid drugs are given intravenously to reduce inflammation and swelling around the affected spinal cord segment. This treatment usually lasts for three to seven days but may be given subsequently to prevent TM recurrence.
  • Plasma exchange therapy is another option for people who do not have success with corticosteroid drugs. Plasma exchange removes plasma along with the antibodies and proteins it contains to relieve excessive immune system activity and its associated inflammation.
  • Intravenous immunoglobulin (IVIG) takes antibodies from healthy individuals and delivers them intravenously to individuals with TM to catch the antibodies causing TM and inhibit them from causing further damage.

Other medications may be prescribed as needed to fight infection, relieve muscle pain or stiffness, address bladder or bowel complaints, reverse sexual dysfunction, and treat depression or anxiety. Additionally, people living with multiple sclerosis or neuromyelitis optica require ongoing treatment to limit or control TM recurrence.

Different forms of rehabilitative therapy, including physical therapy, occupational therapy, vocational therapy, and psychotherapy, are especially necessary for people recovering from TM. Rehabilitative therapy helps individuals restore what quality of life may have been lost or temporarily disturbed by TM symptoms and progression.

There is no cure for TM, but these treatments have proven effective while researchers continue to study this neurological disorder. If you believe you developed transverse myelitis after receiving a vaccination, then contact Gold Law Firm today to speak with a vaccine attorney about your options for compensation.

References

Chandra, A., Rajbhandari, R., Acharya, S.,…Pant, B. (2017). Vaccine induced acute transverse myelitis: Case report. Journal of Neurology & Stroke, 6(2): 00197. DOI: 10.15406/jnsk.2017.06.00197

Grebenciucova, E. (2017, August). Transverse myelitis 101. Retrieved from https://myelitis.org/transverse-myelitis-101/

Lynn, D. J., Levy, C., Kaplin, A.,…Kerr, D. (2015). Transvere myelitis. Retrieved from National Organization for Rare Disorders at https://rarediseases.org/rare-diseases/transverse-myelitis/

Mayo Clinic Staff. (2017, November). Transverse myelitis. Retrieved from https://www.mayoclinic.org/diseases-conditions/transverse-myelitis/symptoms-causes/syc-20354726

National Institute of Neurological Disorders and Stroke. (2018, July). Transverse myelitis fact sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Transverse-Myelitis-Fact-Sheet

National Multiple Sclerosis Society. (n.d.). Transverse myelitis. Retrieved from https://www.nationalmssociety.org/What-is-MS/Related-Conditions/Transverse-Myelitis

Shah, S., Patel, J., Alchaki, A. R.,…Souayah, N. (2018). Development of transverse myelitis after vaccination, a CDC/FDA vaccine adverse event reporting system (VAERS) study, 1985-2017. Neurology, 90(15).

Singh, D., Tisovic, K., & Harth, C. E. (2018). Unique presentation of acquired longitudinally extensive transverse myelitis and GBS overlap syndrome following Tdap vaccination. Neurology, 90(15).

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