Overview
Diagnosis
A doctor diagnoses transverse myelitis based on your medical history, signs and symptoms, a clinical assessment of nerve function, and test results.
Tests used to confirm the condition and rule out other disorders include:
• Magnetic resonance imaging (MRI) – Creates detailed 3D images of soft tissues, showing inflammation of the spinal cord and other abnormalities that may affect the spinal cord or blood vessels.
• Lumbar puncture (spinal tap) – A small amount of cerebrospinal fluid (CSF) is collected to check for elevated white blood cells or immune system proteins indicating inflammation. CSF can also be tested for viral infections or certain cancers.
• Blood tests – May check for antibodies associated with neuromyelitis optica, infections that can contribute to transverse myelitis, or to rule out other causes of symptoms.
Treatment
Treatment focuses on managing acute symptoms, preventing complications, and supporting long-term recovery.
Medications and therapies for acute symptoms include:
• Intravenous steroids – Reduce inflammation in the spinal cord, typically administered over several days.
• Plasma exchange therapy – For those not responding to steroids, plasma is removed and replaced to eliminate inflammatory antibodies.
• Antiviral medications – Used if a viral infection of the spinal cord is identified.
• Pain medications – Chronic pain may be treated with acetaminophen, ibuprofen, or naproxen sodium; nerve pain may be treated with antidepressants like sertraline or anticonvulsants such as gabapentin or pregabalin.
• Other medications – Treat muscle spasticity, urinary or bowel dysfunction, depression, or other complications.
• Preventive medications – People with antibodies linked to neuromyelitis optica may require ongoing corticosteroids or immunosuppressants to prevent recurrent attacks.
Other therapies supporting long-term recovery include:
• Physical therapy – Improves strength, coordination, and mobility; teaches the use of assistive devices such as canes, braces, or wheelchairs.
• Occupational therapy – Helps adapt daily activities such as bathing, cooking, and housework.
• Psychotherapy – Addresses anxiety, depression, sexual dysfunction, and emotional challenges related to transverse myelitis.
Prognosis
Recovery from transverse myelitis varies and may take a year or more. Most improvement occurs within the first three months and depends on the underlying cause.
Approximately one-third of people experience:
• No or slight disability – Minimal lingering symptoms.
• Moderate disability – Mobility challenges, numbness, tingling, and bladder or bowel issues.
• Severe disability – Permanent wheelchair use and ongoing assistance with daily care.
The course and responsiveness to treatment are influenced by the severity and speed of onset, antibody status, and how early treatment begins. Rapid, severe onset and positive antibody tests are associated with a worse prognosis.
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