Transverse Myelitis from pregnancy?

[frankblack007]

My wife and I recently had our first baby.  About five or six months into her pregnancy she developed severe pain in her feet (raising them/icing them down did not help) and some numbness/weakness in her hands, as well as some fairly severe swelling (edemia).  It has been more than one month since the delivery and the pain has not subsided.  We saw a neurologist (our MRI is next week) who said it was probably transverse myelitis and prescribed Lyrica (even though she is breastfeeding and Pfizer said this was not recommended). He didn't think the pregnancy had anything to do with her pain. I did some research and read that if the symptoms don't disappear within 6 months it is likely permanent.  It's been around four months.  Can this be accurate?  I can't believe the pain has nothing to do with her pregnancy.  Nor can I believe that she will walk like a senior citizen for the rest of her life as she is just 34 years old.  Any advice or opinion is greatly appreciated.

[Craig Brooker]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history and examine you, I can not tell you what your diagnosis is per se.  The description of hand and foot pain on both sides in the setting of edema sounds most suggestive of a compression type neuropathy (e.g. carpal tunnel syndrome) that is present because of the swelling.  If that is the case, as the edema resolves, so too should her symptoms.  Lyrica may help her in the meanwhile especially after ~1 month of use or so.  I will defer the implied question regarding Lyrica during breast feeding both to Lyrica's recommendations (that you've already read) and any further discuss between you and your neurologist.  

You, however, also mention your neurologist feels the diagnosis is most likely transverse myelitis.  Such a diagnosis generally has a number more features than you've described thus far, some of which perhaps your neurologist teased out while taking a history, others likely while examining you.  The MRI will likely be very revealing if this is transverse myelitis.  As far as a link between transverse myelitis and pregnancy, there is very little literature on this subject.  A couple of case reports refer to pregnant women getting transverse myelitis but in the setting of another disease process that caused the transverse myelitis.  

Of course following up with your neurologist for further treatment and the MRI report will be important.  

[Fionajnz]

First congrats on your new baby.  I am sorry to read that your wife is so unwell.  Its a really tough time.

I became severely unwell after the delivery of our third child.  One of the differential diagnosis's was transverse myelitis.  In fact I had a pulmonary embolism and a post partum cardiomyopathy, along with an unknown muscle weakness, likely a polymyositis.  So I really do understand how hard it is to be going through this.

I would highly recommend that you get her worked up via a teaching hospital, university hospital or center of excellence.  Medical personnel find it hard to put things together after pregnancy, this is when the OBs step back and no one seems to step forward and say they can help.  I would also recommend that you consult with a rheumatologist, who specialises in immune disorders.  Pregnancy does a number on a womans immune system in order to enable the pregnant woman to carry a pg and not reject it as foreign.  We got some good information from this consult.

In so far as the meds are concerned, the main concern for pediatricians is that a med will cause sleepiness in an infant and cause them not to feed enough and thus gain weight/thrive.  As  they grow it becomes less of a concern because the baby is bigger and absorbs less due to food intake and increasing size.  Most drug companies will say its not a good idea to take meds during lactation as they never study the drug on newborns or breastfeeding Moms, ethics will not allow it.  That said, its not necessarily totally contraindicated.  Of course in an ideal world one would never expose a baby to meds, then it boils down to risk vs benefit.  Consult with a lactation specialist and your peds office and get their support.  There are other options for feeding your baby, you wife can pump and dump (with a hospital grade pump) and you can source human milk from a milk bank, or use formula.  When I was unwell, it came down to risk vs benefit and we initially only fed her with my milk sometimes, added it to formula but ultimately I quit feeding at 9 wks post partum.  I was too stressed to produce enough milk.  I had fed both our other children thru 9 mths, so was really commited to nursing if I could.

I wish you much luck, I am certain that you will work it out, but do be your own best advocates and insist on work ups.  Some things to request is an adrenal work up, some muscle enzyme blood draws, liver function testing, an EMG and of course the MRI.

HOpe that helps you some.  Post back here if you need more information.

Fiona - Mom of 3, age 2, 5 and 8y