Acute transverse myelitis
Acute transverse myelitis (ATM) is an attack of inflammation (swelling) of the spinal cord. It is caused by the body’s immune system becoming mis-programmed and activating immune cells to attack the healthy myelin covering the nerves in the spine.
What causes ATM?
We do not know exactly why this happens, sometimes it can follow on from a viral infection, but sometimes it can also just occur with no prior warning or precipitating event.
What are the signs and symptoms of ATM?
The symptoms of ATM can come on quickly and depend on where in the spine the swelling occurs. If the swelling is in the lower back, then symptoms can include back pain, weakness of both legs and bowel and bladder problems. If the attack is higher, such as around the neck (cervical) area, then both arm and leg weakness can occur and in severe cases breathing can be affected.
How is ATM treated?
Steroid treatment can reduce some symptoms and stop new symptoms from developing. Once the diagnosis is made, steroids are usually given into a vein once a day for the next three to five days. If there is no sign of improvement within a few days, other treatments may need to be considered. Intravenous immunoglobulin can be given, as can a treatment known as plasma exchange. This would be discussed in full detail if needed. At present we do not know the best way to treat ATM, and you may be asked to help us in researching this.
What is the prognosis of ATM?
The long-term prognosis for children with ATM varies and some children do make a very good recovery. A number of children though are left with some motor weakness and/or with residual problems such as weakness in bowel and bladder function. ATM will not affect a child’s thinking.
Will my child get ATM again?
ATM usually only occurs once. Rarely, some children have an underlying cause for the ATM and this would increase their chance of further attacks. Your doctors will do specific tests including blood tests, an MRI brain scan and possibly an eye test to look for further evidence of these conditions.
What happens next?
Once the team looking after a child feels that the time is right, you will be discharged either to your local hospital or to a centre specialising in spinal rehabilitation, depending on your child’s recovery. Follow up will be arranged as needed by the specific members of the multi-disciplinary team.