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In some cases, it seems that developing transverse myelitis can be the initial introduction of multiple sclerosis, but that’s not necessarily the case.

When patients first experience symptoms of multiple sclerosis, it can be scary. The symptoms seem to come out of nowhere, and while they can build over several days, often, they occur with a quicker, more sudden onset over just a few hours. Even for those who have had multiple sclerosis for a while struggle with managing symptoms, so it’s no wonder that the question of a possible diagnosis can be daunting.

However, the same symptoms that suggest the onset of MS could also be related to other conditions. For example, transverse myelitis offers an almost identical experience to the first signs and symptoms of multiple sclerosis. There are vast similarities between the two conditions, leading to a possible misdiagnosis. How is it that a physician or patient can tell the two apart?

What is transverse myelitis?

Transverse myelitis is a neurological and autoimmune condition that results in inflammation and swelling that surrounds a segment of the spinal cord. This inflammation causes damage to the myelin sheath of protection that covers the nerves and nerve fibers, a substance that is also responsible for assuring electrical signals process correctly and at proper speed through the nervous system.

With transverse myelitis, this means that the muscles and body parts controlled by the segment affected, as well as any segment below the damage, cease to function properly, and when there is permanent damage to the central nervous system, this effect on the peripheral nervous system can be permanent.

In most cases, transverse myelitis involves only a single attack, with no return or relapse, though a very small percentage of patients will experience another attack. While there is no cure and no known particular cause of the autoimmune reaction, transverse myelitis almost always develops following one of several specific types of infections.

Transverse myelitis and multiple sclerosis: symptoms and similarities

The symptoms of transverse myelitis and multiple sclerosis are almost identical. In fact, some patients experience transverse myelitis as a precursor to MS or NMO (neuromyelitis optica). In both diseases, females are at much higher risk than men of development, and there is no particular pattern that suggests the diseases are genetic. In both diseases, a patient may experience a sudden onset of symptoms over a few hours, or it might be several days of buildup.

Symptoms that are typical across both conditions include:

  • Weakness, especially in the legs and arms (paraparesis)
  • General, persistent pain, including headache and pain of the musculoskeletal system
  • Numbness, tingling, burning, prickling, or tickling in the extremities, especially feet and toes (paresthesias)
  • Difficulty with bladder and bowel, such as:
    • Frequent urge to urinate
    • Desperate, sudden urge to urinate
    • Incontinence
    • Inability to empty the bladder or bowels completely
    • Constipation and/or diarrhea
  • Extreme fatigue

The process of diagnosis for multiple sclerosis and transverse myelitis are very similar as well. After completing a detailed family history and a thorough neurological exam, the physician will likely request an MRI to look for evidence of multiple sclerosis (or lack thereof), blood tests that look for other potential causes of the symptoms, and a lumbar puncture (spinal tap) that looks for antibodies among the white blood cells that show evidence of an autoimmune reaction.

Some of the treatment options are the same as well.

Options used in both conditions include:

  • Intravenous corticosteroid therapy to reduce inflammation and relieve symptoms
  • Oral steroids to follow up the IV treatment and continue controlling inflammation
  • Plasma exchange that recycles red blood cells but removes the plasma that contains the offending antibodies, with donor or synthetic plasma replacement
  • Immunosuppressants that aggressively douse the immune system, reducing its ability to create the attacking antibodies
  • A particular type of chemotherapy that is often used to treat leukemia and lymphoma that can destroy the offenders

In both diseases, patients may not experience long term effects, but in some cases, there is permanent damage that causes disability and difficulty performing normal daily tasks.

Transverse myelitis and multiple sclerosis: conditions and differences

There are some things that help distinguish the difference between transverse myelitis and multiple sclerosis, including some symptoms that are exclusive to one or the other. For example, only patients with transverse myelitis typically experience severe sensitivity to touch, so that the slightest brush over the skin is uncomfortable, as if someone is poking a bruise. In MS, a patient might experience extreme stiffness or spasms in the limbs. However, this usually only occurs with permanent nerve damage after an attack of transverse myelitis and not as a symptom.

Other differences include:

  • Relapses – In the vast majority of cases, transverse myelitis doesn’t have any relapses, while that is a major indication of MS. In fact, MS won’t be diagnosed unless there have been at least two episodes.
  • MRI – An MRI of a patient with transverse myelitis will show no lesions, or areas of inflammation, in the brain. With MS, there will be at least two lesions developed on at least two separate occasions.
  • Beta interferons and other disease modifying therapies (DMTs) are often prescribed for multiple sclerosis but are not used in transverse myelitis.
  • An additional test, an evoked potential test, will be ordered to help in the diagnosis of MS but is not typically used in diagnosing transverse myelitis.
  • While either condition can be diagnosed at any age, the majority of patients with multiple sclerosis are diagnosed between the ages of eighteen and forty. By contrast, transverse myelitis is most often experienced in patients between the ages of ten and nineteen or between thirty and thirty-nine.
  • Multiple sclerosis is much more prevalent than transverse myelitis. The former is estimated to affect about one million Americans, while transverse myelitis is only estimated to appear in less than two thousand patients annually.
  • While exposure to certain infections might be a risk factor for MS, transverse myelitis almost always follows an infection involving:
    • Zoster viruses, such as chickenpox and shingles
    • Other herpesvirus strains, especially Epstein-Barr, herpes simplex, and cytomegalovirus
    • Flu, echovirus, or rubella
    • Bacterial skin infections or bacterial pneumonia
    • HIV and hepatitis A

Conclusion

In some cases, it seems that developing transverse myelitis can be the initial introduction of multiple sclerosis, but that’s not necessarily the case. In fact, even though the diseases are both autoimmune, neurological conditions, they are mutually exclusive and have a very different pattern of destruction of myelin. It’s important to determine the difference, since transverse myelitis can cause severe and permanent damage, while multiple sclerosis is a progressive disease that requires long term management.

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