Transverse myelitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Treatments are designed to reduce spinal cord inflammation and manage and alleviate symptoms. Initial therapy includes prescription of anti-inflammatory corticosteroid therapy soon after the diagnosis is made in order to decrease inflammation and hopefully improve the chances and speed of neurological recovery. In severe cases that do not appear to respond to corticosteroid treatment, other therapies such as plasma exchange or drug therapies may be used to try to salvage neurological function. Later, if patients begin to recover limb control,physical therapy begins to help improve muscle strength, coordination, and range of motion.
Medical Therapy
Pharmacotherapy
As with many disorders of the spinal cord, no effective cure currently exists for people with transverse myelitis. Treatments are designed to reduce spinal cord inflammation and manage and alleviate symptoms. Physicians often prescribe anti-inflammatory corticosteroid therapy soon after the diagnosis is made in order to decrease inflammation and hopefully improve the chances and speed of neurological recovery. Although no clinical trials have investigated whether corticosteroids alter the course of transverse myelitis, these drugs often are prescribed to reduce immune system activity because of the suspected autoimmune mechanisms involved in the disorder. Corticosteroid medications that might be prescribed may include intravenous methylprednisone or dexamethasone (usually for about 5 days; in some cases, oral prednisone is used for a period of time afterwards). In severe cases that do not appear to respond to corticosteroid treatment, other therapies such as plasma exchange or drug therapies may be used to try to salvage neurological function. General painkillers may be prescribed for any pain the patient may have. And bed rest is often recommended during the initial days and weeks after onset of the disorder.
Following initial therapy, the most critical part of the treatment for this disorder consists of keeping the patient’s body functioning while hoping for either complete or partial spontaneous recovery of the nervous system. This may require placing the patient on a respirator in the uncommon scenario where breathing is significantly affected. Patients are most often treated in a hospital or in a rehabilitation facility where a specialized medical team can prevent or treat problems that afflict paralyzed patients. Often, even before recovery begins, caregivers may be instructed to move patients’ limbs manually to help keep the muscles flexible and strong, and to reduce the likelihood of pressure sores developing in immobilized areas. Later, if patients begin to recover limb control, physical therapy begins to help improve muscle strength, coordination, and range of motion.
Rehabilitation
Today, most rehabilitation programs attempt to address the emotional dimensions along with the physical problems resulting from permanent disability. Patients typically consult with a range of rehabilitation specialists, who may include physiatrists (physicians specializing in physical medicine and rehabilitation), physical therapists, occupational therapists, vocational therapists, and mental health care professionals.
Physical Therapy
Physiatrists and physical therapists treat disabilities that result from motor and sensory impairments. Their aim is to help patients increase their strength and endurance, improve coordination, reduce spasticity and muscle wasting in paralyzed limbs, and regain greater control over bladder and bowel function through various exercises. Physiatrists and physical therapists teach paralyzed patients techniques for using assistive devices such as wheelchairs, canes, or braces as effectively as possible. Paralyzed patients also learn ways to avoid developing painful pressure sores on immobilized parts of the body, which may lead to increased pain or systemic infection. In addition, physiatrists and physical therapists are involved in pain management. A wide variety of drugs now exist that can alleviate the pain that results from spinal cord injuries such as those caused by transverse myelitis. These include nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen; antidepressant drugs such as amitryptyline (tricyclic) and sertraline (a selective serotonin reuptake inhibitor); muscle relaxants such as baclofen or tizanidine, and anticonvulsant drugs such as gabapentin, pregabalin, and carbamazepine.
Occupational Therapy
Occupational therapists help individuals learn new ways to maintain or rebuild their independence by participating in meaningful, self-directed, goal-oriented, everyday tasks (occupations) such as bathing and dressing. They teach people how to function at the lightest level possible, by developing compensatory strategies, suggesting changes in their homes to improve safety (such as installing grab bars in bathrooms), changing obstacles in their environment that interfere with normal activity, and instructing on how to use assistive devices.
Vocational Therapy
In addition to acquainting people with their rights as defined under the Americans with Disabilities Act of 1990 and helping people develop and promote work skills, vocational therapists identify potential employers, assist in job searches, and act as mediators between employees and employers to secure reasonable workplace accommodations.