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Subject: Re: TRANSVERSE MYELITIS
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD on June 28, 1997 at 03:20:41:
In Reply to: TRANSVERSE MYELITIS posted by Karen Deckard on June 17, 1997 at 18:50:19:
: I was diagnosed in May 1996 with acute Transverse Myelitis. I have a
brother and sister diagnosed with it also. All 3 within a 2 1/2 year
period. We have had MRI's, spinal taps, etc. to rule out MS. We all have
residual numbness and pain of varying degrees. Two of us have pain in
chest wall, axilla, and back. The other has pain in legs. Do you see
cases that appear to be familial? Do you know of any case studies of
etiology being done? I suspect a genetic autoimmune cause for us.
What pain control methods work best? Among us we use a TENS, Tylenol #4,
and Duragesic patches. My sister ia allergic to codeine, Demerol,
and Duragesic. We have all been treated by Dr. Robert Taylor of OSU
Medical Center in Columbus, OH who sees us at Licking Memorial Hospital
in Newark, OH. We are very confident of his care, but wonder if there
is anything new to learn. I am an R.N. so you don't necessarily have to
use lay terms.
Thank you very much for this opportunity.
Karen Deckard
gregdeckard@alink.com
=
Dear Karen:The history you relate is extremely fascinating. Obviously, the nature of the problem you and your sibs have is undetermined. Thinking about potential causes: 1) Hereditary spastic paraparesis can be confidently excluded because the condition is dominantly motor. 2) MS does have some degree of familial tendency to it. The risk of a sib getting MS is commonly quoted as being 5%. Familial clustering (of more than two cases) of MS has been reported, but is distinctly rare. 3) Mitochondrial DNA mutations (specially LHON - 11778) have been reported to cause MS like illnesses, but commonly involve the eyes. 4) HTLV-I is a chronic retroviral infection that causes a myelopathy, and has been described in families. It is, however, mainly prevelant in some specific geographical areas, and is rare in most parts of the US. 5) Other infections, such as Lyme, herpesviruses, prion, etc are plausible, but would be conjectural. 6) A familial systemic autoimmune condition, based on shared HLA alleles, is possible, but rare. 7) The syndrome does not seem to fit commonly seen nutritional or toxic conditions.
No, we do not commonly see your problem - it is practically reportable.
I do not know the best answer to the pain problems you and your sibs suffer from. The question is best addressed to a pain specialist.
OSU is a very reputed institution with an excellent neurology department, and I am sure you and your sibs get excellent care there.
If, however, you do want another opinion, we would be very happy to see you here at the Cleveland Clinic. Your problem would be best addressed at the Mellen Center (affiliated to the neurology department here) which deals with MS and related disorders. The number you might want to call up for appointments is (800) 223-2273. This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.
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