Tropical Spastic Paraparesis

Tropical spastic paraparesis is a slowly progressing viral immuno-mediated spinal cord injury caused by human T-lymphocyte virus type 1 (HTLV-1). A spastic paresis of both legs develops. The diagnosis is confirmed by data from serological samples and by PCR studies of blood and CSF. Conduct immunosuppressive and symptomatic therapy.

Causes of the tropical spastic paraparesis

Human T-lymphocyte virus type 1 belongs to the group of retroviruses and is transmitted during sexual contact, intravenous injection of drugs or blood transfusion, while breastfeeding. The disease is common among prostitutes, drug addicts, patients on hemodialysis, and individuals from endemic equatorial regions, for example, in the south of Japan and parts of South America. A similar disorder is caused by a human T-lymphocyte virus type 2 (HTLV-2).

The virus is in the T-cells in the blood and CSF. In the spinal cord, perivascular and parenchymal infiltration of CD4 by memory T-cells, CD8 by cytotoxic T cells, macrophages and astrocytes has been revealed. Within a few years after the debut of neurological manifestations, the inflammation of the gray and white matter of the spinal cord progresses, leading to a predominant degeneration of the lateral and posterior canopies. Also myelin sheath and axons of the anterior cords are affected.

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Symptoms of the tropical spastic paraparesis

Gradually, spastic paresis of both legs with extensor plantar reflexes and a symmetrical loss of vibration sensitivity on the feet increase. Achilles reflexes are often absent. Characterized by incontinence and rapid urge. The disease progresses for several years.

Diagnostics of the tropical spastic paraparesis

Suspicion should occur in the presence of a characteristic neurological deficit, especially in a patient at risk. Conduct a serological and PCR study of blood and CSF, as well as MRI of the spinal cord. If the ratio of the antibody level to HTLV-1 in the CSF to its serum level greater than 1 or PCR reveals HTLV-1 antigen in the CSF, the diagnosis is highly likely. The protein and lg level in the CSF are usually elevated, in 1/2 cases, lymphocytic pleocytosis is evident. On MRI in a suspended mode, foci in the spinal cord are visible as bright zones.

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Treatment of the tropical spastic paraparesis

There is no effective method of treatment. Apparently, the use of interferon alfa, intravenous immunoglobulin and methylprednisolone intravenously is useful. Spasticity is treated symptomatically.