Transverse myelitis

Key Case Details

• Patient: Female, 45 years old
• Treatment Start Date: July 2019
• Diagnosis: Transverse myelitis (associated with a high titer of Herpes Zoster antibodies)
• Treatment Method: A single intravenous and intrathecal (into the spinal canal) administration of allogeneic umbilical cord-derived mesenchymal stem cells (MSCs).
• Complaints: Leg weakness and anesthesia (loss of sensation) of the lower limbs.
• Neurological Status: Anesthesia of the lower limbs below the Th5 dermatome. Deep tendon reflexes:  in the upper limbs,  in the lower limbs, weak. Urinary incontinence. Muscle strength: MRC 5 in the upper limbs, MRC 2 in the lower limbs.
• MRI (11.03.2019): Atrophic changes of the spinal cord at Th5–Th8. Spinal cord edema at the level of C4–Th4, paramagnetic contrast accumulation at Th1–Th10 (Fig. 1).
• Laboratory Findings: High levels of antibodies to Herpes Zoster in the blood.

What is Transverse Myelitis?

Transverse myelitis is an acute inflammatory disease of the spinal cord that damages the myelin sheath of nerve fibers. This leads to impaired conduction of signals from the brain to organs and limbs. In our patient, the disease was triggered by the herpes virus (Herpes Zoster), which caused edema and atrophic changes in the thoracic and cervical spinal cord.

Fig.1. Thoracic spine MRI before treatment

Fig.2. Thoracic spine MRI 4 month after treatment

Comparison of the MRI picture of the spinal cord:

Before treatment: Spinal cord edema C4–Th4 and large inflammatory accumulation Th1–Th10.

After treatment (04.11.2019): The edema completely disappeared. Paramagnetic accumulation of contrast significantly decreased and remained localized only at the micro level of Th7–Th8. Atrophic changes were localized exclusively in the Th5–Th6 segments.

Patient’s Condition Before Therapy

The patient turned to QR Clinic complaining of a complete inability to move independently, loss of sensation in the lower body, and pelvic organ dysfunction.

Results of the Neurological Examination:

• Sensitivity (anesthesia): Complete loss of sensation below the level of the thoracic vertebra Th5 (chest area).
• Motor activity (muscle strength): Muscle strength of the upper limbs is normal (MRC 5), muscle strength of the lower limbs is critically reduced to MRC 2 (the patient can make only minimal movements in the joints in a horizontal plane, but is unable to overcome gravity or lift a leg).
• Pelvic organ functions: Persistent urinary incontinence (need for constant catheterization).

MRI of the thoracic spine (from 11.03.2019): Pronounced spinal cord edema at the level of C4–Th4 segments was detected. Paramagnetic contrast accumulation at the level of Th1–Th10 (indicating active inflammation) and initial atrophic changes in the spinal cord at the level of Th5–Th8 were also recorded.

Cell Therapy Program at QR Clinic

Given the infectious and inflammatory nature of the disease, it was decided to use a cell product with high anti-inflammatory and regenerative potential – mesenchymal stromal cells (MSCs) from the umbilical cord.

On July 13, 2019, the patient underwent a combined intravenous administration and intrathecal infusion of a suspension of allogeneic mesenchymal stem cells obtained from the umbilical cord of a healthy donor.

Expected result: Umbilical cord MSCs have a unique ability to suppress autoimmune inflammation, reduce the activity of inflammatory cytokines, and stimulate neuroregeneration (restoration of damaged nerve sheaths).

Dynamics and Treatment Results (after 4 months)

4 months after the stem cell transfusion, the patient underwent a follow-up MRI scan and a neurological examination. The results demonstrated stable positive dynamics.

Restoration of pelvic organ functions:

• Before treatment: Complete urinary incontinence.
• After treatment: Urination function has fully recovered. The patient no longer has problems with urinary incontinence, which has critically improved her quality of life.

Improvement of sensitivity and motor functions:

• Before treatment: Anesthesia below Th5, muscle strength of the legs MRC 2.
• After treatment: The sensitivity limit dropped significantly lower — to the level of Th10 (sensitivity in the upper abdomen was restored). Muscle strength of the legs increased to MRC 3 — the patient is now able to lift her legs independently and counteract gravity, which is the basis for further walking rehabilitation.

Conclusions

The use of umbilical cord stem cells allowed to quickly stop the active inflammatory process in the spinal cord, which did not respond to standard drug therapy. Elimination of the edema created conditions for partial regeneration of nerve fibers. The patient continues scheduled follow-up (3, 6, and 12 months) and undergoes an active physical rehabilitation course to consolidate the result.

Frequently Asked Questions (FAQ)

Do stem cells help with transverse myelitis?

Yes. Mesenchymal stem cells (MSCs) have an anti-inflammatory effect. They can help eliminate spinal cord edema, protect nerve cells from further destruction (neuroprotection), and promote regeneration of the myelin sheath.

What cells are used to treat myelitis at QR Clinic?

We use autologous (patient’s own) mesenchymal stem cells (MSCs) from the patient’s fat, or allogeneic (donor) cells obtained from the umbilical cord or placenta of healthy donors. They have the highest therapeutic potential and do not cause a rejection reaction.

How quickly do the first treatment results appear?

In the presented clinical case, a significant regression of symptoms (restoration of urinary control, reduction of the level of anesthesia, and restoration of leg movements) was recorded as early as 4 months after therapy, which is confirmed by MRI data.