The tropical spastic paraparesis / HTLV-1 associated myelopathy (TSP / HAM) is a slowly progressive, viral, immune-mediated disease of the spinal cord and is caused by the human T-lymphotropic virus 1 (HTLV-1). It causes spastic paralysis of both legs. The diagnosis is made by serological tests and PCR of serum and cerebrospinal fluid. Treatment includes supportive care and possibly immunosuppressive therapies.

(See also overview of diseases of the spinal cord.)

The tropical spastic paraparesis / HTLV-1 associated myelopathy (TSP / HAM) is a slowly progressive, viral, immune-mediated disease of the spinal cord and is caused by the human T-lymphotropic virus 1 (HTLV-1). It causes spastic paralysis of both legs. The diagnosis is made by serological tests and PCR of serum and cerebrospinal fluid. Treatment includes supportive care and possibly immunosuppressive therapies. (See also overview of diseases of the spinal cord.) HTLV-1 is a retrovirus that is transmitted through sexual contact, i.v. drug use or breastfeeding from mother to child. It is most common in prostitutes, consumers of i.v. drugs, hemodialysis patients and people from endemic areas such as the equatorial region, southern Japan and parts of South America. TSP / HAM relates to <2% the support of HTLV -1. It is more common in women; This finding is consistent with the higher prevalence of HTLV-1 infection in women. HTLV-2 can cause a similar problem. The virus infects T lymphocytes in blood and cerebrospinal fluid. CD4 + memory cells, cytotoxic CD8 + T cells and macrophages infiltrate the perivascular areas and the Rückenmarkparenchym; it occurs astrocytosis. Several years after the onset of neurological symptoms, the inflammation of the spinal gray and white matter proceeds, whereby preferably the lateral and posterior columns degenerate. Also myelin and axons in the front pillar lost. Symptoms and signs Spastic paresis develops gradually in both legs, with positive Babinski sign and bilateral symmetric loss of position and vibration sensation in the feet. The Achilles tendon reflexes are often missing. Urine and urge incontinence are common. The symptoms usually exceed continued for many years. Diagnosis The diagnosis is based on serological tests and PCR of serum and cerebrospinal fluid. TSP / HAM may be accepted if typical neurologic deficits are present that are otherwise unexplained, v. a. in patients with risk factors. Serum and Liquorserologie, PCR and MRI of the spinal cord are indicated. When the cerebrospinal fluid serum ratio of HTLV-1 antibody> 1 or if verified by a PCR HTLV-1 antigen in the cerebrospinal fluid, the diagnosis is very likely. The protein and IgG levels in the cerebrospinal fluid may also be increased, often with oligoclonal bands; lymphocytic pleocytosis occurs in up to 50% of patients. Spinal cord lesions often appear hyperintense on T2-weighted sequence. Immunomodulatory treatment or immunosuppressive therapies To date, no treatment has been proven effective, but interferon-?, iv immunoglobulins and oral methylprednisolone may bring some benefit. The treatment of spasticity is symptomatic (z. B. baclofen or tizanidine).

Health Life Media Team

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