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Tropical spastic paraparesis
Last reviewed: 04.07.2025
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Tropical spastic paraparesis is a slowly progressive viral immune-mediated spinal cord lesion caused by human T-lymphocyte virus type 1 (HTLV-1). Spastic paresis of both legs develops. The diagnosis is confirmed by serological tests and PCR studies of blood and CSF. Immunosuppressive and symptomatic therapy is administered.
Causes tropical spastic paraparesis
Human T-lymphocyte virus type 1 is a retrovirus and is transmitted through sexual contact, intravenous drug use, blood transfusions, and breastfeeding. The disease is common among prostitutes, drug addicts, hemodialysis patients, and people from endemic equatorial regions such as southern Japan and parts of South America. Similar disorders are caused by human T-lymphocyte virus type 2 (HTLV-2).
The virus resides in T cells in the blood and CSF. The spinal cord shows perivascular and parenchymatous infiltration of CD4 memory T cells, CD8 cytotoxic T cells, macrophages, and astrocytes. Over the course of several years after the onset of neurologic manifestations, inflammation of the gray and white matter of the spinal cord progresses, leading to predominant degeneration of the lateral and posterior funiculi. The myelin sheath and axons of the anterior funiculi are also affected.
[ Symptoms tropical spastic paraparesis
Spastic paresis of both legs gradually increases with extensor plantar reflexes and symmetrical loss of vibration sensitivity in the feet. Achilles reflexes are often absent. Incontinence of urine and frequent urges are characteristic. The disease progresses over several years.
Diagnostics tropical spastic paraparesis
Suspicion should be raised by characteristic neurological deficits, especially in a high-risk patient. Serologic and PCR testing of blood and CSF are performed, as well as MRI of the spinal cord. If the CSF to serum HTLV-1 antibody ratio is greater than 1 or PCR detects HTLV-1 antigen in the CSF, the diagnosis is highly probable. CSF protein and Ig are usually elevated, and lymphocytic pleocytosis is evident in 1/2 of cases. On weighted MRI, lesions in the spinal cord appear as bright areas.
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Treatment tropical spastic paraparesis
There is no effective treatment. Apparently, the use of interferon alpha, intravenous immunoglobulin and oral methylprednisolone are useful. Spasticity is treated symptomatically.