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Suggest Treatment For Acute Transverse Myelitis In Child

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Posted on Tue, 24 Nov 2015
Question: Hi,

My Name is XXXX, i am from XXXXXXX my contact no is +91 0000.

My daughter is 5 years old, she is suffering with acute transverse myelitis since 16 march 2015.

Her condition is same as first day of disease. We already gave her IVIG, and PLEX also.

So please guide me some solution on this on urgent basis
doctor
Answered by Dr. Prof. Kunal Saha (1 hour later)
Brief Answer:
It might often be hard to treat such a condition.

Detailed Answer:
Thanks for asking on HealthcareMagic.
I am sorry to know about your daughter. Transverse myelitis is an inflammation of the spinal cord, which often targets myelin, the insulating material covering nerve cell fibers. The disrupted transmission of nerve signals due to transverse myelitis can cause pain or other sensory problems, weakness or paralysis of muscles, or bladder and bowel dysfunction. There are a number of conditions that appear to cause this. It can be due to:
* Viral and other infections of the respiratory tract or the gastrointestinal tract.
* Multiple sclerosis, a disorder in which the immune system destroys myelin surrounding nerves in your spinal cord and brain. It is in this case that IVIG could be helpful. Plasma exchange (PLEX) or plasmapheresis attempts to wash away the antibodies from the blood.
* Neuromyelitis optica (Devic's disease), a condition that causes inflammation and loss of myelin around the spinal cord and the optic nerve. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body.
* Autoimmune disorders affecting other body systems likely contribute to transverse myelitis in some people.

Since the most important modalities of treatment have already been tried, the next lines of treatment can be IV cyclophosphamide or IV methylprednisolone.

Nondrug therapies also need to be tried:
* Physical therapy - helps in increasing strength and improving coordination.
* Occupational therapy - helps in learning new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.
* Psychotherapy - helps in managing associated anxiety, depression and other emotional or behavioral issues that may be related to coping with transverse myelitis.

I understand the situation might seem bleak but the treatment has to be attempted depending upon the scenario.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (4 hours later)
Dear Sir,

Thank you for your revert.

We already gave her IV cyclophosphamide or IV methylprednisolone.

But her condition not yet recover in last 7 months. She having problem with lower body...below waist....her upper body properly working. We already examine her brain and eyes also....Her lower body not responding...she lost her senses and movement both... In every four hour we have to use that Instant Feeding Tube for urnine...Physiotherapy also going on...We already loose hope...and she is also not ready to accept this.

I am afraid one more thing... if she not recover as soon as possible...and if she loose her temperament...then what we will do...cuz she is only 5 years old...I ready many articals on this disease....but i not get any positive response from anywhere....
doctor
Answered by Dr. Prof. Kunal Saha (7 hours later)
Brief Answer:
It might not always be easy to deal with such an ailment

Detailed Answer:
Thanks for asking back. Sorry for not being able to respond earlier.

You need to understand that you are not dealing with an 'easy' disease. The expectations need to be rationalized. You have to face life as it comes. It all depends upon the perspective of life. Psychotherapy is essential to help you restructure the expectations and morale. It involves the participation of both you (parents) as well her.

You will have to bear patience. I clearly understand that there has not been good response to treatment. But still, treatment has to be attempted step by step. Please go through the following articles:
http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/transverse_myelitis/about-tm/treatment.html ( Skip to 'Other treatments for transverse myelitis' section )
Treatment with monoclonal antibodies is the next modality that can be suggested. Please go through:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
and also
http://www.neurology.org/content/82/10_Supplement/P5.181

A present day recommendation guideline to treatment of transverse myelitis can be found at:
http://www.neurology.org/content/77/24/2128.full.pdf+html

Regards
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4467 Questions

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Suggest Treatment For Acute Transverse Myelitis In Child

Brief Answer: It might often be hard to treat such a condition. Detailed Answer: Thanks for asking on HealthcareMagic. I am sorry to know about your daughter. Transverse myelitis is an inflammation of the spinal cord, which often targets myelin, the insulating material covering nerve cell fibers. The disrupted transmission of nerve signals due to transverse myelitis can cause pain or other sensory problems, weakness or paralysis of muscles, or bladder and bowel dysfunction. There are a number of conditions that appear to cause this. It can be due to: * Viral and other infections of the respiratory tract or the gastrointestinal tract. * Multiple sclerosis, a disorder in which the immune system destroys myelin surrounding nerves in your spinal cord and brain. It is in this case that IVIG could be helpful. Plasma exchange (PLEX) or plasmapheresis attempts to wash away the antibodies from the blood. * Neuromyelitis optica (Devic's disease), a condition that causes inflammation and loss of myelin around the spinal cord and the optic nerve. Transverse myelitis associated with neuromyelitis optica usually affects both sides of your body. * Autoimmune disorders affecting other body systems likely contribute to transverse myelitis in some people. Since the most important modalities of treatment have already been tried, the next lines of treatment can be IV cyclophosphamide or IV methylprednisolone. Nondrug therapies also need to be tried: * Physical therapy - helps in increasing strength and improving coordination. * Occupational therapy - helps in learning new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning. * Psychotherapy - helps in managing associated anxiety, depression and other emotional or behavioral issues that may be related to coping with transverse myelitis. I understand the situation might seem bleak but the treatment has to be attempted depending upon the scenario. Regards