Myelitis is a medical term referring to inflammation in the spinal cord. Myelitis can be caused by a variety of conditions, such as autoimmunity or infections.
Your spinal cord protects your nerves and allows electrical signals to travel between your brain and the rest of your body. Damage to the spinal cord can cause neurological symptoms, including muscle weakness, numbness, pain, and bladder problems.
UPMC neurology experts provide advanced care for myelitis, including medications, plasma exchange, intravenous immunoglobulin therapy, pain management, and rehabilitation.
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What Is Myelitis?
Myelitis is a medical term referring to inflammation in the spinal cord. Myelitis can be caused by a variety of conditions, such as autoimmunity or infections.
The spinal cord protects your nerves and allows electrical signals to travel between your brain and the rest of your body. Damage to the spinal cord can cause neurological symptoms, including muscle weakness, numbness, pain, and bladder problems.
What are the types of myelitis?
Myelitis may be:
- Partial — Affecting only one side of your body.
- Transverse — Affecting one or more levels of your spinal cord and causing symptoms below those levels.
What causes myelitis?
Myelitis is caused by spinal cord inflammation.
The inflammation itself can be idiopathic (having no known cause), or can be caused by:
- Autoimmune conditions — Myelitis can occur in the setting of central nervous system disorders, such as multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody disorders (MOGAD), neurosarcoidosis, and acute disseminated encephalomyelitis. Myelitis rarely occurs in the setting of rheumatoid arthritis, sarcoidosis, scleroderma, Sjögren’s disease, lupus, and ankylosing spondylitis.
- Infections — Common causes include enteroviruses, herpes, HIV, varicella-zoster (chicken pox and shingles), Lyme disease, Zika virus, West Nile virus, syphilis, tuberculosis, bacterial infections, and more.
- Vascular factors — Vascular diseases that affect blood flow to the spine by reducing oxygen or cancer-related immune reactions.
How common is myelitis?
Myelitis is a frequent complication of conditions such as MS, NMOSD, and MOGAD, especially when untreated. Infectious myelitis is rare.
Myelitis risk factors
You may be at higher risk of myelitis if you have been diagnosed with an autoimmune or central nervous system condition or have had a recent infection. In some cases, myelitis is the first symptom of a central nervous system or autoimmune condition.
Complications of myelitis
Myelitis may cause permanent disability that ranges from problems with walking and bowel or bladder issues to complete paralysis.
How can I prevent myelitis?
If you have an autoimmune condition, taking medications to control the immune system, as prescribed by your doctor, can reduce the chance of having myelitis.
What Are the Signs and Symptoms of Myelitis?
Symptoms of myelitis can develop quickly over hours/days, or progressively over weeks/months, depending on the cause. They can quickly become severe and affect parts of the body below the damaged area of your spinal cord.
Symptoms may include:
Abnormal sensations
Abnormal sensations include:
- Burning.
- Loss of or more intense sensitivity to temperature or touch.
- Numbness.
Pain
Pain symptoms may:
- Feel achy, dull, or sharp.
- Feel like a band around your chest or abdomen.
- Radiate down your arms and legs.
Bowel and bladder problems
Bowel and bladder symptoms may include:
- Constipation.
- Difficulty emptying your bladder.
- Loss of bladder control.
- Urine leakage.
- Urgent need to urinate.
Movement and muscle problems
Depending on the part of your spinal cord affected, myelitis may cause weakness that begins in your arms or legs and rapidly worsens.
Other symptoms may include:
- Difficulty walking.
- Loss of balance.
- Loss of muscle function.
- Muscle spasms.
Other symptoms
Other symptoms of myelitis may include:
- Difficulty breathing.
- Sexual problems.
When should I see a doctor about my myelitis symptoms?
If you have symptoms of myelitis, you should dial 911 or go to the nearest hospital Emergency Department. Getting early treatment can reduce your risk of permanent damage or serious complications.
How Do You Diagnose Myelitis?
To diagnose myelitis, your doctor will perform physical and neurological examinations and review your symptoms and medical history. Your doctor will also order tests to confirm your diagnosis or rule out other problems.
What to expect during your visit
During your visit, your doctor will:
- Ask you about your symptoms.
- Order tests.
- Perform a physical and neurological exam.
- Review your medical history.
Tests to diagnose myelitis
Your doctor will order tests to gather information or rule out other conditions, including:
- Blood and urine tests — Checks for abnormalities and rules out other conditions.
- Cerebral spinal fluid analysis (spinal tap or lumbar puncture) — Involves inserting a needle into your lower back to collect a sample of cerebrospinal fluid (CSF) for analysis in a lab.
- Magnetic resonance imaging (MRI) — Takes images of your brain and spine using contrast dye to look for damaged or abnormal areas.
- Neurological examination — Checks your reflexes, balance, movement, memory, and ability to think.
Myelitis prognosis
Many people experience only one episode of myelitis. However, people who have autoimmune or central nervous system disorders may experience more than one episode.
About one-third of people make a complete recovery, one-third have moderate disability, such as difficulty walking, and one-third have permanent paralysis.
Your prognosis depends on the severity of your symptoms, the rate at which they began, the location of the nerve damage, the rate at which your condition improves, and other factors. Your doctor will discuss your prognosis with you.
What is the survival rate for myelitis?
Nearly all people who are diagnosed with myelitis survive, but some may have permanent damage that ranges from mild to severe.
How Do You Treat Myelitis?
The goals of myelitis care are to treat the underlying cause if known, reduce inflammation, relieve symptoms, and decrease the risk of long-term complications. Treatment typically involves short-term care to treat acute symptoms and long-term care to manage complications.
Short-term myelitis care
Short-term myelitis care may include:
- Intravenous immunoglobulin therapy (IVIG) — During IVIG, you will receive an intravenous injection of donor immunoglobulins or antibodies. Immunoglobulins are a natural part of your immune system and protect your body by attacking foreign organisms. Immunoglobulins may prevent your immune system from further damaging your nerves.
- Medication — Corticosteroids given through an IV may reduce inflammation in your spinal cord. Your doctor may also prescribe medications to suppress your immune system or manage other symptoms.
- Plasma exchange (plasmapheresis) — Plasmapheresis involves using a machine to separate the liquid part of your blood, called plasma, from your blood cells. Your plasma is then filtered to remove the antibodies that are causing nerve damage before being returned to your body.
Long-term myelitis care
Long-term myelitis care may include:
- Bowel and bladder care — Includes treatments to improve bowel and bladder function.
- Mental health care — Includes treatments for depression or anxiety, including medication and talk therapy.
- Pain management — Medications may be used to treat muscle and nerve pain.
- Rehabilitation — Although damage caused by myelitis is irreversible, physical and occupational therapy can help improve stiffness, mobility, strength, balance, and overall function.
- Sexual health care — Treatments may include medication for erectile dysfunction and other sexual problems.
- Skin care — Involves preventing pressure ulcers (bedsores) and skin infections.
Why Choose UPMC for Myelitis Care?
When you choose UPMC for myelitis care, you will receive:
- Multidisciplinary care — Our team of neurologists and autoimmune disease experts will work together to develop a customized treatment plan that reduces your risk of complications.
- Access to advanced clinical trials — Our team participates in national, multicenter clinical trials evaluating new treatment options, allowing you to contribute to research advancing care for autoimmune and central nervous system disorders.
- Seamless, ongoing treatment — If you are diagnosed with myelitis, our team will develop a follow-up care plan that includes ongoing rehabilitation and symptom management as needed.
- Bench-to-bedside research — We have faculty members who are actively researching MS and other neuroimmunologic disorders.
