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Acute Transverse Myelitis

  • Acute Transverse Myelitis (ATM) involves a brief but intense attack of inflammation (swelling) in the spinal cord that damages myelin. Myelin is the protective covering of nerve fibers. Myelin is also called "white matter" due to its color. Because ATM affects myelin, it is a type of "demyelinating" disorder.  The spinal cord transmits information between the brain and the body. ATM usually affects the middle (thoracic) portion of the spinal cord. In some cases, it can affect the upper (cervical) portion of the spinal cord.

    How Children’s approaches Acute Transverse Myelitis

    Boston Children's Hospital treats children with ATM through our Pediatric Multiple Sclerosis and Related Disorders Program.  The program team is led by doctors specializing in demyelinating disorders, and includes a pediatric neuropsychologist, a nurse and a social worker.

    Facts about Acute Transverse Myelitis
    • Most children with ATM make a complete or nearly complete recovery.
    • The main medication for treating ATM is a type of steroid.
    • Most children tolerate the medication very well.
    •  While ATM is related to multiple sclerosis (MS), ATM typically occurs only once, and only in the spinal cord, while a patient with MS has further, repeated attacks in both the brain and spinal cord.

  • In-Depth

    What causes Acute Transverse Myelitis (ATM)?

    ATM is an "autoimmune" condition that often follows an infection, such as a cold. The immune system protects the body from invaders, like bacteria and viruses.

    Autoimmune diseases confuse your child's immune system. Instead of fighting against bacteria or viruses, it attacks healthy cells and tissue.

    If your child has ATM, her immune system reacts against her spinal cord. Autoimmunity is not contagious, but may be genetic (inherited from parents).

    ATM may also happen after a child is vaccinated, although this is rare. In some cases of ATM, a specific trigger/cause cannot be identified.

    What are the symptoms of ATM?

    The symptoms of ATM come on quickly and can include:

    • pain
    • weakness
    • numbness or tingling
    • loss of bowel and bladder function

    Weakness and numbness occur on both sides of the body, which is why it is called "transverse."

    If the thoracic portion (middle) of your child's spinal cord is affected, her legs will be affected, but her arms won't.

    If the cervical portion (upper) of your child's spinal cord is affected, both her arms and legs can be affected. In severe cases, breathing can be affected.

    What is the prognosis of ATM?

    Steroid treatment can reduce some symptoms and stop new symptoms from developing.

    Although the long-term prognosis for children with ATM varies, most children make a complete or nearly complete recovery, including those children with initially severe symptoms.

    For most children, recovery begins within days and continues for up to one year. Motor function usually improves faster than bowel and bladder function.

    Some patients can have residual symptoms such as weakness, numbness or urinary problems.

    Will ATM affect my child's school performance?

    Because ATM doesn't affect the brain, most children perform as well as they ever did at school. However, some children do fall behind in their school work. This could be the result of missed school days during the illness.

    If you notice changes in your child's school performance, it is important to let your doctors and nurses know so that we can work with the school to develop an educational plan.

    Will my child get ATM every time she has an infection?

    No. In more than 90 percent of patients, ATM occurs only once. In some patients, it can re-occur. It is not known why patients develop ATM with certain infections at certain times.

    If you notice symptoms during an infection that you think are unusual, such as weakness, numbness or imbalance, it is important to notify your child's doctor immediately.

    How is ATM similar to multiple sclerosis (MS)?

    • Both ATM and MS involve autoimmune responses to myelin in the spinal cord. They are both "demyelinating" disorders.
    • Symptoms common to both disorders include weakness, numbness and bowel and bladder problems.
    • Corticosteroids are used to treat attacks of ATM and MS.

    How is ATM different from MS?

    • ATM typically occurs only once, while patients with MS have further, repeated attacks of inflammation in the brain and spinal cord.
    • Most patients with MS are treated with ongoing medication to prevent such attacks. Patients with ATM don't require such medication.

    Can a child with ATM ever develop MS in the future?

    Although it is uncommon, children who initially have ATM can later develop MS. Children who have the "complete" form of ATM with more severe symptoms actually appear to be at lower risk of developing MS than patients with "partial" ATM.

    Regardless of which form of ATM your child has, it is important for her to have ongoing follow-up care. Let the doctor know immediately if your child develops new symptoms, such as:

    • visual loss
    • weakness
    • numbness
    • loss of balance
  • Tests

    How is Acute Transverse Myelitis (ATM) diagnosed?

    There is not one specific test that is used to diagnose ATM. There are several exams and tests that the doctors must look at including:

    • your child's medical history
    • a neurological examination
    • spine MRI scan to check for swelling in the spinal cord and rule out causes other than ATM
    • brain MRI scan to make sure there is no swelling in the brain
    • a lumbar puncture (spinal tap) to make sure that there is no infection in the spinal fluid, such as meningitis or encephalitis
    • blood tests to look for infectious triggers and for other conditions which can be confused with ATM
  • Testing and treatment of ATM usually requires a child to be hospitalized for one to two weeks.

    Medications are used to reduce the inflammation (swelling) in the spinal cord. The main medication that is used is called methylprednisolone (Solu-medrol®), which is a corticosteroid given by IV once a day for three to five days. This medication is completely different from the illegal steroids that some athletes use.

    Most children with ATM improve with high doses of methylprednisolone. If this medication doesn't work, there are other treatments that can be tried (such as plasmapheresis or intravenous immunoglobulin therapy).

    What are the side effects of the treatment?

    Most children tolerate the steroids (the medication) very well. But in some children there are side effects such as:

    • temporary moodiness or other behavioral changes
    • increases in blood pressure and blood sugar, which your child's doctor or nurse will be monitoring and can treat if necessary
    • irritated stomach lining, which can be prevented with a medication such as ranitidine (Zantac®)

    Will my child leave the hospital on medications?

    Some children will be placed on a steroid called prednisone for a short period of time. Your child may also be prescribed a medication to prevent stomach irritation.

    If your child is experiencing pain, a pain management plan will be developed.

    What will the follow-up be after my child is discharged from the hospital?

    After discharge from the hospital, some children go to a rehabilitation hospital to work on things like strength and balance. Some children go home and work with a physical therapist.

    It is important to follow up with the neurologist in the outpatient clinic. The neurologist will check your child's neurological examination, and will also perform a follow-up MRI.

    Will the abnormalities on the MRI go away?

    In most children, the abnormalities on the MRI will significantly improve or go away completely. Some areas may have a small "scar." Your child's doctor will use the follow-up MRI to make sure that there are no new abnormalities developing.

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