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Old 03-01-2009, 01:03 PM
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Harrison Harrison is offline
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Default Dr. Bowen on Transverse Myelitis

Question & Answer Column:
Dr. James Bowen

Swedish Medical Center NeuroScience Institute
Multiple Sclerosis Center

Dr. James Bowen authored, Acute Viral Infections of the Spinal Cord, a concise article summarizing the various causes of transverse myelitis (inflammation) of the spinal cord. We caught up with him in the midst of his transition into a new position at the Swedish Neuroscience Institute. Though his schedule was frenetic, he was kind enough to field some questions focused on his interesting article on transverse myelitis (TM).

ADRSupport: Dr. Bowen, I understand that you’ve recently transitioned as the Director of Neurology Services at the University of Washington Multiple Sclerosis center into a new position at the SwedishMedicalCenter. What is the focus of your new position (and your research) as it relates to the spinal cord and nervous system?

Dr. Bowen: I am the medical director for the Multiple Sclerosis Center at Swedish Neuroscience Institute. This Center focuses on treating people with demyelinating diseases such as multiple sclerosis, transverse myelitis, and others. We offer comprehensive services specializing in these diseases including neurology, rehabilitation, diagnostics, physical and occupational therapy, speech therapy, bladder management, rehabilitation psychology, pain management, social services and vocational counseling. In March 2009 we are opening the first portions of our wellness center with educational offerings, exercise facilities, smoking cessation, bone health consultations, and dietary counseling. We have a robust research program that focuses on the development of new treatments for demyelinating diseases, including those that affect the spinal cord.

ADRSupport: What connection is there, if any, between transverse myelitis (TM) and degenerative spinal diseases? Have any of the causes of TM been specifically linked to spinal conditions such as disc herniation, lesions, stenosis, sacroiliitis, spondylitis, spondyldiscitis or spondylarthritis? If there is a link, what percent of the population does this phenomenon effect?

Dr. Bowen: There are many causes of injury to the spinal cord. Some are obvious, such as trauma or blockage of the blood supply (stroke). Injury may also be caused by pinching of the spinal cord from disc herniation, bone spurs (spondylosis), or a narrowing of the space through which the spinal cord passes (spinal stenosis). Transverse myelitis is the medical term for spinal cord damage due to inflammation, which is the result of an attack by the immune system. This immune attack may be directed against a known target such as a virus infecting the spinal cord. More commonly, the target for the attack cannot be identified. In this situation we assume that the immune attack is directed against a virus that we cannot identify, or that the immune system is inappropriately directly targeting the spinal cord. Thus, the cause of spinal cord injury from transverse myelitis is quite different from other causes such as mechanical pinching, trauma or stroke. The conditions are not really linked except that they all must be considered as possibilities by physicians trying to determine the cause of spinal cord symptoms.

ADRSupport: What research has been done in this area? Who is doing it? What does the data tell us about this linkage, if anything?

Dr. Bowen: Most of the research in this area involves investigating the cause of specific diseases of the spinal cord. Many centers are investigating better ways to treat mechanical spinal cord lesions such as compressive lesions from discs or stenosis. Others are studying the immunology underlying transverse myelitis and inflammatory spinal cord diseases like multiple sclerosis. The Transverse Myelitis Association and the National Multiple Sclerosis Society are two organizations that promote research in these diseases.

ADRSupport: In one report you cited, as many as 40% of the TM cases were preceded by an upper respiratory infection. How do pathogens travel from the airway to the spinal cord?

Dr. Bowen: We do not have a complete understanding of this. In many cases, we assume that the virus enters the bloodstream through the upper respiratory regions. From the bloodstream, the virus travels throughout the body. Some of these viruses have the ability to infect the spinal cord, causing myelitis symptoms. In other cases, the virus may not actually invade the nervous system, but rather proteins on the surface of the virus may resemble normal proteins of the nervous system. An immune attack on the virus could then result in collateral damage to the spinal cord because of the similarities in the protein structures.

ADRSupport: Once the pathogens reach the spinal cord, what happens to them? Can they travel deeper into connective tissue? What are the factors that determine whether or not they reach the CSF?

Dr. Bowen: Factors that allow some viruses to invade the nervous system, but not other viruses are only partially understood. In most cases, viruses infect cells by actually crossing the cell membrane and entering the interior of a cell. The virus usually binds to a protein on the surface of the cell that allows it to cross over the cell membrane. Viruses have evolved to bind to particular proteins, which leads different viruses to infect different cell types in the body. Thus viruses that enter the nervous system are those that have proteins on their surface that bind to cells of the nervous system.

ADRSupport: What are the most common clinical symptoms of TM? One common symptom in TM seems to be a stiff neck – why is that? What nerves are affected? E.g., spinal accessory, median, cranial?

Dr. Bowen: Transverse myelitis is due to involvement of the spinal cord. The nerves exiting the spinal cord are usually spared, with the exception of nerves that are right at the location of the inflammation. The main symptoms are therefore spinal cord symptoms. These involve weakness below the level of the lesion, spasticity (stiffness, increased reflexes) and sensory symptoms. Sensory symptoms may consist of numbness (if the sensory signal fails to reach the brain) or inaccurate sensations (paresthesias, due to signals reaching the brain with jumbled signals). Bowel and bladder symptoms are also common.

ADRSupport: For what period of time can pathogens lay dormant in or around the spine without causing harm? What factors may reawaken them?

Dr. Bowen: Many viruses may lay dormant in the body for years. Common examples include fever blisters which are due to a herpes virus caught in childhood that stays dormant for a lifetime, only to come out of dormancy from time to time. Another example is chickenpox which lies dormant in nerves for a lifetime. When chickenpox activates in adults, it is called shingles. It is likely that most of these viruses are able to remain dormant for a lifetime without causing harm, or at least causing only occasional inconveniences to people. What awakens these viruses remains a mystery. It is likely that there is a balance between the virus and the immune system, and that changes in this balance allow the virus to activate, but these factors are poorly understood.

ADRSupport: Regarding the causal factors of TM, what are some of the trends you’ve seen in the last two years, if any?

Dr. Bowen: We have a much better understanding of how to diagnose transverse myelitis in the past few years. In 2002, criteria for diagnosing transverse myelitis were first published, providing a framework to more accurately diagnose the disease. There have been improved means of diagnosing infectious causes of transverse myelitis. For example, PCR techniques have allowed earlier diagnoses of infections. Several new viruses have been discovered in recent years. Another trend is improving measures of immune system activity. For example, an antibody that binds a particular protein (aquaporin 4) has recently been linked to a particular disease, neuromyelitis optica.

ADRSupport: In terms of diagnostics for TM, are there any new technologies on the horizon that will help doctors pinpoint specific causes of TM?

Dr. Bowen: Improvements in detecting infectious causes include PCR techniques. I expect the number of available tests to expand allowing us to diagnose a wider variety of pathogens causing these diseases. There are also improvements in imaging techniques such as MRI scanning. These scans allow us to see many more lesions that we could previously. There are newer imaging techniques that hold promise for measuring the actual amount of damage that occurs. Finally, I expect future advances in immunology to allow us to better classify these diseases, improving our diagnoses and allowing us to more accurately direct treatments.

ADRSupport: Thanks so much for your time, Doctor Bowen. Good luck in your new position too!

Dr. Bowen: My pleasure. Good health to you and all the people at ADRSupport.
"Harrison" - info (at)
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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spinal cord infection, spinal cord inflammation, spinal immunology, spinal myelogram, spine arthritis, transverse myelitis

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