Transverse myelitis
| Classification according to ICD-10 | |
|---|---|
| G37 | Other demyelinating diseases of the central nervous system |
| G37.3 | Acute transverse myelitis in demyelinating disease of the central nervous system |
| ICD-10 online (WHO version 2019) | |
The transverse myelitis (TM) (gr. Μυєλός myelós is meant for "Mark" spinal cord, lat. Transversus for "transversely", "the cross-section on") is a rare neurological disease characterized by a group of neuroimmunological diseases of the central nervous system heard.
Description and frequency
Diseases similar to transverse myelitis are acute disseminated encephalomyelitis (ADEM), optic neuritis and Devic's syndrome ( neuromyelitis optica ). All of these diseases are characterized by inflammation of the central nervous system . They differ primarily in the position of the inflammation and whether the inflammation occurs once or several times.
Many of the symptoms are the same, so the treatment strategies are similar. Almost all age groups can develop TM. It occurs most frequently in the age groups between 10 and 19 and between 30 and 49 years with the same gender distribution. The specialist literature speaks of a frequency of 1.34 TM diagnoses per million people per year.
Causes and development, role of the immune system
TM can occur in isolation or in connection with another disease. If it occurs for no apparent cause, it is called idiopathic . An abnormal activation of the immune system , which is then directed against the spinal cord itself, seems to be responsible. TM often develops in association with viral or bacterial infections .
Diagnostic procedures
- MRI scan of the spinal cord ( magnetic resonance imaging )
- Analysis of the cerebrospinal fluid (cerebral and spinal fluid )
Course of the disease, forms, symptoms
The appearance of the symptoms can vary greatly - it depends on which level of the spinal cord is affected and how badly the myelin cortex and nerve cells are damaged. The symptoms and possibly lasting consequences of TM can include muscle weakness , motor paralysis up to paraplegia , sensory disorders and uncomfortable nerve sensitivity, pain due to damage to nerve tracts, spastic paralysis , exhaustion, depression , malfunctions of the rectum and urinary bladder as well as sexual disorders .
Therapy, treatment, rehabilitation
Various medications are given in acute therapy: cortisone , antibiotics and antivirals . A plasma exchange therapy can be used if necessary.
Rapid first aid is particularly important and one of the decisive factors for the success of the treatment.
After the end of acute therapy, intensive rehabilitation should follow. This is based on rehab after spinal column damage and aims to restore physical abilities. Physiotherapy is used to remedy central muscle weakness, counteract spasticity and work against coordination disorders . Physical therapy helps with heat applications and baths against pain and functional restrictions. The neurological rehabilitation helps to prevent anxiety and / or depression and strengthens the confidence in the own performance of the affected people.
The therapy program includes i. d. Usually a mix of physiotherapy (formerly: physiotherapy), massages , rod baths ( electrotherapy ) and activation or relaxation treatments (e.g. hydrojet, water massage bed or mediwave, mat with bass vibrations). Self-training is very important for the time after rehab; sometimes a therapy program is put together for at home. Various symptom-related drugs can be given for longer periods of time.
forecast
At the onset of the disease, a prognosis about the course is often not possible. Improvement or recovery usually occurs within two to twelve weeks after the acute event. For some people, it can take up to two years, and for some, symptoms do not resolve completely. However, if treatment is started early, many patients recover completely or almost completely.
TM is i. d. Usually a disease that occurs only once. A small percentage may relapse, especially in patients with multiple sclerosis or neuromyelitis optica . The presence of antibodies to the water channel protein aquaporin-4 in the blood of patients with myelitis is associated with a high risk of a relapse or the development of additional optic neuritis within 12 months; In these cases, immunosuppressive therapy is recommended to prevent relapse.
Technical article
Individual evidence
- ↑ Rare neuroimmunological diseases: an overview (01/2006) (PDF; 52 kB)
- ↑ Pathology of Transverse Myelitis (10/2003) (PDF; 180 kB)
- ↑ Medical first aid for transverse myelitis (9/2007) ( Memento of the original from July 14, 2015 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Neuroimmunological diseases of the central nervous system (2007) (PDF; 38 kB)
Web links
Orphanet:
- Transverse myelitis. In: Orphanet (Rare Disease Database).
Definition:
Self-help groups:
