Transverse Myelitis Vaccine Injuries
What is Transverse Myelitis (TM)?
Transverse myelitis (TM) is an inflammatory disease that causes injury to the spinal cord with varying degrees of weakness, sensory alterations, and autonomic dysfunction. Inflammation within the spinal cord interrupts communications between nerve fibers in the spinal cord and the rest of the body, affecting sensation and nerve signaling below the injury.
Transverse myelitis generally presents with rapidly progressing muscle weakness or paralysis, beginning with the legs and moving to the arms with varying degrees of severity. Sensation is diminished below the level of spinal cord involvement in the majority of individuals. Pain and temperature sensation are usually diminished and joint position sense and the ability to feel vibrations are decreased. Most individuals diagnosed with transverse myelitis report a tight banding or girdle-like sensation around the trunk, with the area being very sensitive to touch. Approximately 80% of cases reach their peak deficits 10 days after the onset of their symptoms.
How is TM diagnosed?
Diagnosis of TM is based on clinical and radiological findings. First, a magnetic resonance imaging (MRI) of the spinal cord is obtained to assess if there is a compressive or inflammatory lesion on the spinal cord. Next, a lumbar puncture is used to look for elevated white cell counts, elevated protein and an elevated IgG index in the cerebrospinal fluid (CSF).
Intravenous steroid treatment is the first line of therapy often used in acute TM. Plasma exchange (PLEX) is utilized in moderate to severe TM in individuals who show little clinical improvement after first initiating the intravenous steroid treatment. PLEX is a way of removing blood plasma and exchanging it with blood products to be donated to the recipient. The removed plasma is discarded, and the patient receives replacement donor plasma, albumin, or a combination of albumin and saline. PLEX has been shown to be effective in adults with TM and other inflammatory disorders of the central nervous system.
What is the prognosis?
Most people with transverse myelitis have at least partial recovery, with most recovery taking place within the first 3 months after the attack. For some people, recovery may continue for up to 2 years (and in some cases, longer). However, if there is no improvement within the first 3 to 6 months, complete recovery is unlikely (although partial recovery can still occur and still requires rehabilitation).
Aggressive acute treatment and physical therapy have been shown to improve outcomes. Some individuals are left with moderate disability (such as trouble walking, nerve sensitivity, and bladder and bowel problems) while others may have permanent weakness, spasticity, and other complications. Myelitis attacks with neuromyelitis optica spectrum disorder (NMOSD) tend to be more severe and are associated with less recovery than attacks with multiple sclerosis. Research has shown that a rapid onset of symptoms generally results in poorer recovery.
What treatment is available?
Treatments are designed to address infections that may cause the disorder, reduce spinal cord inflammation, and manage and alleviate symptoms. Intravenous corticosteroid drugs, plasma exchange therapy (plasmapheresis), intravenous immunoglobulin (IVIg), pain medicines, and antiviral medications have all been used to treat individuals with transverse myelitis. Usually, physicians will utilize one of these treatment regimens and determine its success before moving to another treatment.
Can TM be caused by vaccines?
Transverse myelitis can be caused by other immune system disorders, viral infections, bacterial infections and fungal infections. Vaccinations for infectious diseases — including influenza, hepatitis B, measles-mumps-rubella and diphtheria-tetanus vaccines — have occasionally been associated as a possible trigger for transverse myelitis.
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