Myelitis

Myelitis is the inflammation of spinal cord. Spinal cord is the extension of brain into vertebral column (back bone). Myelitis can result in weakness of both lower limbs along with difficulty or loss of control of urine and stools.

When myelitis involves upper part of spinal cord, it can result in weakness of all limbs along with problems in urinary and fecal control. This usually occurs suddenly and may or may not be accompanied with back pain.

Sometimes myelitis may be a part of more widespread disease like multiple sclerosis or neuromyelitis optica spectrum disorder. You may ask your doctor regarding this.

Treatment:

Patient needs urgent hospitalization for at least couple of weeks. High dose intravenous steroids need to be given. In some cases, intravenous immunoglobulin or plasmapheresis treatment needs to be done.

Recovery:

Recovery is usually slow and is often incomplete. Eventually patient may be able to walk with help of support.

Physiotherapy:

Physiotherapy is of paramount importance for myelitis patients. After hospital treatment, physiotherapy is the mainstay of treatment. Each joint should be gently stretched to the range of motion several times a day. It should be continued indefinitely until affected legs/arms become fully functional. Visits to physiotherapist are also as important as visits to doctors.

Diet:

Patient needs to take well balanced diet. Overweight patient should lose weight to have better chances of recovery. Patients who are bed or wheel chair ridden need less calories than normal human and hence should not over-eat. Obesity can negatively affect mobility and recovery.

Frequently Asked Questions:

Can we take the patient to family gatherings etc.?

Yes. Patient should not be confined to just one room. Patient should be taken to TV room, terrace, lawn etc. Patient should also be taken on outings, dinners and family functions when possible. Patients who cannot walk independently should use walking aids or wheel chair. Patients should be taken regularly to parks so that they can enjoy sunshine and fresh air. It is very important for mental health and early recovery of patient.

Can myelitis patient offer prayers and do fasting?

It depends on functional status of patient. If patient can keep himself clean, then he can definitely offer prayers. Patient can also fast if patient can tolerate fasting easily. Patients with diabetes should discuss with their doctor regarding fasting.

What are general precautions regarding stroke patients?
  • Patients should take medicines regularly as advised by doctor. Even if patient cannot see doctor due to some reason, dose should not be missed.
  • Overweight patients need to lose weight. They can have better chances of mobility this way.
  • Physiotherapy is as important as is medication treatment. Physiotherapy needs to be continued indefinitely.
  • While mobilizing the stroke patients, extreme caution should be exercised to prevent any fall. Falls can result in fractures that may take months to heal. Particularly over-weight patients are at higher risk.
  • Patients should regularly visit treating doctor as advised. In case doctor visit is missed, previous medicines should be continued until next visit.
When will recovery occur?

Recovery in myelitis patients is slow and may be incomplete. Physiotherapy remains main stay of treatment after being discharged from hospital. Do not lose heart and keep your spirits high. You still can be useful part of society. Many professions do not require walking or any physical work. Examples being: Call Centre Operators, Software professionals, Online teachers, writers etc.  Being overweight or obese, negatively impacts your chances of independent walking.

Can myelitis occur again?

Some patients who are suffering from multiple sclerosis, neuromyelitis optica spectrum disorders and other conditions can have myelitis again.

Can we give bath to myelitis patient?

Yes, definitely.  It is highly recommended to keep patient neat and clean. Patient may be given bath twice a week. Patient may be bathed daily if need arises. Patient should be kept as clean as possible. Special care should be given to patients who are on diapers or having urinary catheters.  Cleanliness of perineal area should be ensured. Seepage of urine from catheter should be brought into notice of doctor/nurse when it occurs. Patient should be kept dry at all times especially after bath and after attending toilet needs. Patients should also brush their teeth at least once daily. They can also use hair oil, moisturizers and deodorants like healthy persons.

What should be bedding arrangements of paralyzed patients?

Patients who are bed ridden should have air mattress put over regular mattress. Air mattress should be turned on all the time while patient is on bed. Patient should be educated to change sides after every 30 minutes. If patient is unable to do so, family should help changing sides of patient. This will minimize the chances of developing bed sores. Back and hips of patient should be inspected regularly to see any signs of bed sores. If any redness of skin or skin break is noted, treating doctor should be informed at earliest. Head end of bed should be kept slightly higher than foot end. Bed sheets should be changed daily.  Patient should be discouraged from lying in bed all times. They should only be on bed at night time or may be for couple of hours after lunch. Patients who have severe weakness and cannot stand unaided should be put in wheel chair or sofa or any other chair during day time. Legs should not hang down for prolonged period of time. For example, if patient has to sit for long time, another chair or table etc. should be kept under the legs of patient and legs should be extended at knees.

Does massage (Maalish) help the patient?

While massage with any oil or lubricant can help keeping the skin healthy but it does not help regain the strength in paralyzed limb. Physiotherapy should be done in preference to massage. Massage does NOT help in regaining muscle strength. Physiotherapy is MUST for all patients. Massage may be done if patient enjoys it.

How to manage toilet needs of patient?

If the patient can walk with help then he should be taken to toilet. If patient can sit, toilet chair should be used. Patient should be washed and dried adequately afterwards. If patient is not fully conscious or passes urine/stool without informing, then diaper can be used but it should be used as last option. Diaper should be frequently changed. Patient on diapers are more prone to infections.

Does the wild pigeon yakhni/soup/broth help? Should we give yakhni/soup to patient?

Yakhni/soup/broth intake is always over emphasized in our population. Yakhni/soup/broth of chicken, wild pigeon or mutton does NOT help in any way. In fact, excessive use of salt in soup can be harmful to patient. If it has to be given, it should have less salt. It is advisable to give patient a well-balanced diet.

Disclaimer:
The information given here is intended for use of general public . It should not be taken as standard medical reference.

About the Author:

One of the most well known neurologists in Lahore, he is serving as Assistant Professor of Neurology at Lahore General Hospital. He is a graduate of King Edward Medical College and did residency in general medicine & neurology at Mayo Hospital Lahore. He did FCPS in neurology and moved to Lahore General Hospital, and has been working there since.

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