Health Library

Myelitis

Myelitis can be caused by several different things, such as infection or an autoimmune process. With an autoimmune disorder, the body’s immune system doesn’t function correctly. Instead of protecting against foreign objects, the body starts attacking its own healthy tissue.

Myelitis is not present at birth. It develops as the immune system matures. It often starts showing symptoms during childhood, but can happen in adults as well.

Treatment is important to maintain the best possible health and function. Typically, children who have myelitis have a good recovery. Recurrence is rare but can occur. Risk of recurrence depends on the underlying reason for myelitis. Sometimes lasting symptoms such as weakness, numbness, difficulty with peeing and pooping or control of these things can occur.

What Causes Myelitis?

There are several causes of myelitis. Some infections that can cause myelitis include enterovirus, West Nile virus, tuberculosis and HIV. Autoimmune diseases that can cause myelitis include multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD). It can also be associated with rheumatologic diseases such as lupus, sarcoidosis or Sjogren’s disease.

Sometimes a cause is not found, and a patient is diagnosed with idiopathic myelitis.

What are the Symptoms of Myelitis in Children?

Symptoms can be different from child to child. Not all children will have all symptoms listed.

Common symptoms for myelitis in children include:

• Numbness or tingling in the chest, abdomen, arms, legs
• Muscle weakness in the arms and legs
• Difficulty walking
• Pain in the legs, arms, back
• Muscle stiffness in the arms and leg, spasticity
• Difficulty, urgency or incontinence with bowel movements and/or urinating (peeing)

How is Myelitis Diagnosed?

A neurologist is a doctor who specializes in conditions that affect the brain and nerves. The doctor will ask about symptoms and do a neurologic exam. The doctor tests vision, hearing, sensation and strength. Coordination, balance and reflexes are also tested.

To confirm that a child has myelitis, doctors use additional tests. The main tests are:

• Imaging
• Magnetic resonance imaging (MRI). This test uses a large magnet and radio waves to take pictures of the spinal cord.
• Spinal tap. The doctor will remove a sample of fluid surrounding the brain and spinal cord. The lab tests for signs of inflammation and helps rule out other causes such as infection.
• Blood work. This rules out other infectious and inflammatory diseases that may have similar symptoms.
• Other tests may be considered depending on the child’s symptoms and results of the above tests.

What are the Treatment Options for Myelitis?

The categories of myelitis treatment include:

• Early antibiotic/antiviral treatment. Used while infectious causes are ruled out, for 24-48 hours. Not all children will be on an antibiotic or antiviral treatment.
• Treatment of active inflammation. There are three common treatments used while in the hospital to help reduce inflammation and the autoimmune response. Treatments are typically completed in the hospital.
• Steroids often are given through an IV to reduce inflammation from an active flare-up.
• IVIG. This is an infusion of immunoglobulins (antibodies) that helps prevent the immune system from attacking the normal tissue.
• Plasma Exchange (PLEX). This is a procedure where blood is slowly filtered, antibodies are removed, and cleaned blood is returned to the patient.
• Prevention of further relapses. Medications called immunotherapies or immunosuppressants may be needed to prevent future relapses. This often includes continuing steroids by mouth, or IVIG. Regular visits to the hospital are needed for IVIG infusions.
• Treatment of symptoms related to myelitis. Medications used to treat symptoms vary depending on the symptoms caused by myelitis. These medications may be used only during active inflammation or may be needed long term. Occupational, speech and physical therapies are used to help recovery from symptoms. Most children need at least one of these services as they recover from myelitis, and the therapies could be needed from a few weeks to months.

The cause of myelitis determines how likely it is to recur and whether additional treatments are needed. Doctors will help guide that discussion and will watch closely for new symptoms and repeat testing as needed.

Myelitis Long-Term Outlook for Children

Many patients may only have one myelitis attack. Most children recover well with timely therapy with steroids, IVIG and/or plasmapheresis. Recovery usually happens over weeks to months. The risk of having another episode of myelitis depends on what caused the first episode. Ongoing symptoms can include weakness, numbness, pain, stiffness/spasticity, difficulty with peeing, pooping and control of those things.