Tropical spastic paraparesis

Tropical spastic paraparesis
HTLV-1 which causes TSP
Classification and external resources
Specialty
ICD-10	G04.1
DiseasesDB	29487
eMedicine	med/1038
Patient UK	Tropical spastic paraparesis
MeSH	D015493

Tropical spastic paraparesis (TSP) is a medical condition that causes weakness, muscle spasms, and sensory disturbance by Human T-lymphotropic virus resulting in paraparesis, weakness of the legs. As the name suggests, it is most common in tropical regions, including the Caribbean. Blood transfusion products are screened for HTLV-1 antibodies, as a preventive measure.

Signs and symptoms

Some of the signs of Tropical spastic paraparesis are:

• Leg instability
• Urinary dysfunction.
• Bowel dysfunction
• Back pain
• Erectile problems
• Psoriasis

Polymyositis

Patients with TSP may also exhibit uveitis (inflammation of the uveal tract of the eye), arthritis (inflammation of one or more joints), pulmonary lymphocytic alveolitis (inflammation of the lung tissues), polymyositis (an inflammatory muscle disease), keratoconjunctivitis sicca (persistent dryness of the cornea and conjunctiva), and infectious dermatitis (inflammation of the skin).

HTLV-1 can be transmitted via breastfeeding (mother to child), sexual contact, via blood contact (transfusion or reuse of same needle).

Pathogenesis

In Tropical spastic paraparesis, HTLV-1 shows elevated cellular acquired immune response as well as high production of proinflammatory cytokines. IFN overexpression has been demonstrated as well. Also the number of NK cells (CD56+ and CD16+) is diminished.

Treatment

Immunoglobulin

The treatment of TSP can be done via corticosteroids to help with inflammation. Though any success with corticosteroids is short-lived with symptoms worsened as the dosage is reduced. A synthetic derivative, 17-alpha-ethinyltestosterone, can be used to treat Tropical spastic paraparesis, improvement in motor and bladder function was reported but not sustainable.

Mogamulizumab, an anti-CCR4 IgG1 monoclonal antibody, is also being researched for possible treatment for Tropical spastic paraparesis. The antibody reduces HTLV-1 proviral load and production of proinflammatory cytokines. Valproic acid has also succeeded in reducing the proviral load of HTLV-1 (though clinical benefits were minimal or none). A further combination of valproic acid and zidovudine has demonstrated a decrease in proviral loads (in animals).

Prognosis

The prognosis for Tropical spastic paraparesis indicates improvement in a percentage of cases due to immunosuppressive treatment. Though a higher percentage will eventually lose the ability to walk in a ten-year range.

History

For several decades, the term tropical spastic paraparesis was used to describe a chronic and progressive clinical syndrome that affected adults living in equatorial areas of the world. This condition was initially thought to be associated with infectious agents (such as Treponema pertenue and Treponema pallidum, which cause inflammation of the central nervous system) and with chronic nutritional deficiencies (such as avitaminosis) or exposure to potentially toxic foods (such as bitter cassava).

Tropical myeloneuropathies are described via two syndromes -tropical ataxic neuropathy (TAN) and tropical spastic paraparesis (TSP). They are placed together because tropical countries is where they occur, further tropical spastic paraparesis has occurred in temperate countries (e.g., Japan).

External links

• International Retrovirology Association