Chronic progressive myelopathy associated with HTLV‐I

Link, Hans; Cruz, Mabel; Gessain, Antoine; Gout, Olivier; Thé, Guy de; Kam‐Hansen, Slavenka

doi:10.1212/wnl.39.12.1566

Cited by 52 publications

(29 citation statements)

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“…The CSF examination revealed the inflammatory origin of this disease in 89% of patients, consistent with the literature (95%) 13,15 . There was a higher frequency of acute signs of inflammation characterized by pleocytosis (64%) compared to previous studies (26%) 15 .…”

Section: Discussionsupporting

confidence: 89%

“…The albumin quotient (CSF/ serum) assessed the presence of dysfunction of the blood-CSF barrier (Q alb≥8x10 -3 ), whereas the IgG index (Q IgG/Q albumin) ≥0.7 and/or detection oligoclonal IgG bands in CSF showed intrathecal synthesis of total IgG 13 . We used the specific antibody index (AI) to determine the intrathecal synthesis of anti-HTLV-1 (AI≥1.5) 14,15 .…”

Section: Csf Analysismentioning

confidence: 99%

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HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings

Puccioni-Sohler

Gasparetto

Cabral‐Castro

et al. 2012

Arq. Neuro-Psiquiatr.

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OBJECTIVE: To investigate the association between clinical data, white matter lesions and inflammatory cerebrospinal fluid (CSF) findings in HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). METHOD: We studied brain and cervical spinal cord on magnetic resonance imaging (MRI) and CSF examinations of 28 Brazilian HAM/TSP patients. RESULTS: The majority of patients had severe neurological incapacity with EDSS median of 6.5 (3-8). The brain MRI showed white matter lesions (75%) and atrophy (14%). The preferential brain location was periventricular. Cervical demyelination lesions occurred in 11% of the cases, and cervical atrophy in 3.5%. One patient had enhancement lesions on T1 cervical spinal cord MRI. Cases with spinal cord lesions had signs of acute CSF inflammation. The brain white matter lesions predominated in the patients with higher age. CONCLUSION: Our data suggest that an active inflammatory process is associated with the cervical spinal cord lesions in HAM/TSP. The brain abnormalities are not related to the clinical picture of HAM/TSP.

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Section: Discussionsupporting

confidence: 89%

Section: Csf Analysismentioning

confidence: 99%

HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings

Puccioni-Sohler

Gasparetto

Cabral‐Castro

et al. 2012

Arq. Neuro-Psiquiatr.

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“…This method was used to demonstrate that the oligoclonal IgG was directed against T. pallidum in neurosyphilis, 5 against herpes simplex virus (HSV)-specific glycoproteins in HSV encephalitis and against HTLV-1-specific proteins in HTLV-1 myelopathy. 6,14,15 Our technique has several advantages over these methodologies. For example, we were able to utilize less than 100μl of CSF with microgram amounts of antibody and visualize less than 1μg of eluted protein by silver-staining, as compared with the milligram quantities of purified IgG required for immunocomplex sedimentation.…”

Section: Discussionmentioning

confidence: 99%

“…3,6 Thus, the OGBs seen exclusively in the CSF are part of a larger immune response in both the CSF and periphery that is directed against the causative agent. Herein, we developed a technique to absorb OGBs directed against specific antigens and determined the specificity of OGBs present in the CSF of a patient with VZV vasculopa-thy.…”

mentioning

confidence: 99%

Oligoclonal immunoglobulins in cerebrospinal fluid during varicella zoster virus (VZV) vasculopathy are directed against VZV

Burgoon

Hammack

Owens

et al. 2003

Annals of Neurology

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Limited analyses of cerebrospinal fluid from patients with central nervous system infections have shown that the oligoclonal IgG is antibody directed against the agent that causes disease. Using a new method involving binding of IgG to beads coated with lysates prepared from candidate infectious antigens, we showed that the oligoclonal IgG in cerebro-spinal fluid of a patient with chronic varicella zoster virus vasculopathy is directed against the causative virus. This approach holds promise in identifying and purifying the relevant oligoclonal IgGs in inflammatory central nervous system diseases of unknown cause.Clinical pathology laboratories define oligoclonal immunoglobulin (Ig) as discrete bands seen on isoelectric focusing gels of cerebrospinal fluid (CSF), typically near the cathode, that are not present in serum of the same patient. These oligoclonal bands (OGBs) are found most often in chronic infectious diseases of the central nervous system (CNS). In diseases in which the specificities of the OGBs have been determined, the bands have been shown to be antibody directed against the infectious agent that caused disease (reviewed in Gilden and colleagues 1 ). For example, most OGBs in subacute sclerosing panencephalitis (SSPE), a form of chronic measles encephalitis, are directed against measles virus (MV). 2,3 Similarly, OGBs in cryptococcal meningitis and neurosyphilis are antibody directed against Cryptococcus neoformans 4 and Treponema pallidum, 5 respectively. OGBs are also found in other inflammatory CNS diseases of unknown cause, such as multiple sclerosis, sarcoidosis, and Behçet's disease. Identification of the specificity of those oligoclonal Igs might be key in determining the cause of these disorders.In chronic infectious CNS diseases, additional bands of IgG have been found in both the CSF and serum of the same patient and have been shown to be antibody directed against the same antigen. 3,6 Thus, the OGBs seen exclusively in the CSF are part of a larger immune response in both the CSF and periphery that is directed against the causative agent. Herein, we developed a technique to absorb OGBs directed against specific antigens and determined the specificity of OGBs present in the CSF of a patient with VZV vasculopa-thy. Materials and Methods Cerebrospinal Fluid SamplesA CSF sample obtained at the onset of VZV vasculopathy 5 months after bilateral sacral distribution zoster contained a high titer of anti-VZV-specific IgG. 7 The CSF was frozen at -20°C. At the time of this study, enzyme-linked immunosorbent assay (ELISA) reconfirmed the presence of anti-VZV antibody in CSF, the quality of VZV antigen in the VZV-infected cell lysate, and the presence of antibody to measles virus in the CSF of an SSPE patient (a gift from Dr B. Vandvik, Oslo, Norway) (Table). CSF protein concentra-tions were determined by bicinchoninic acid (BCA) protein assay (Pierce, Rockford, IL). Enzyme-Linked Immunosorbent AssayTo assess initial virus specificity by ELISA, we tested the CSFs on VZV-infected, MVinfect...

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“…In addition, isoelectric focusing and silver-stain was performed to detect oligoclonal IgG bands. The presence of bands restricted in CSF or with two or more bands in CSF, not found in serum, were considered as intrathecal IgG production 10 .…”

Section: Laboratory Studiesmentioning

confidence: 99%

HTLV-I associated myelopathy in patients from Brazil and Iran: neurological manifestations and cerebrospinal fluid findings

Puccioni-Sohler¹,

Kitze

Felgenhauer

1995

Arq. Neuro-Psiquiatr.

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SUMMARY -We analysed sera and cerebrospinal fluid (CSF) of 20 cases of human T-cell lymphotropic virus type (HTLV-I) associated myelopathy/tropical spastic paraparesis (HAM/TSP) from Brazil and Iran and as controls, 16 Brazilian HTLVI seronegative individuals afflicted with other neurological diseases. It was observed in the HAM/TSP patients that: 1) all had an inflammatory reaction within the central nervous system (CNS); 2) 95% (19/20) showed oligoclonal bands reflecting intrathecal IgG synthesis; 3) 85% (17/20) presented a local synthesis of HTLVI antibodies; 4) 35% (7/20) had a measurable immunoglobulin (Ig) synthesis within the CNS. The CSF parameters of the HAM/TSP were compared with the clinical data (age at onset, duration of disease and disability level). Our data prove that CSF analysis is important for the diagnosis of HAM/TSP. There is no association between the severity of the disease and CSF findings.KEY WORDS: HTLV-I, HAM/TSP, cerebrospinal fluid, multiple sclerosis. Mielopatia associada a HTLV-I em pacientes do Brasil e do Irã: manifestações neurológicas e achados no líquido cefalorraquidianoRESUMO -Foram analisadas amostras de líquido cefalorraquidiano (LCR) e plasma de 20 pacientes com mielopatia associada ao HTLV-I (HAM/TSP) provenientes do Brasil e Irã e como controle, 16 de indivíduos brasileiros soronegativos para HTLV-I acometidos por outras doenças neurológicas (esclerose múltipla, epilepsia idiopática e mielopatia de etiologia desconhecida). Observou-se no grupo de pacientes com HAM/TSP: 1) reação inflamatória no SNC em todos os casos; 2) 95% (19/20) mostravam bandas oligoclonais refletindo síntese intratecal de IgG no SNC; 3)85% (7/20) apresentavam síntese local de anticorpos para HTLV-I; 4)35% (tinham síntese mensurável de imunoglobulinas no SNC. Os parâmetros do LCR dos pacientes com HAM/TSP foram comparados aos dados clínicos (idade de início, duração da doença e grau de incapacidade). Os dados apresentados neste estudo indicam a importância da analise do LCR para diagnóstico de HAM/TSP. Entretanto nenhuma associação entre a gravidade da doença e os achados do LCR foi demonstrada.PALAVRAS-CHAVE: HTLV-I, mielopatia, HAM/TSP, líquido cefalorraquidiano, esclerose múltipla.Since the last century, cases of spastic paraparesis with unknown etiology were reported in tropical countries. The presence of HTLV-I antibodies was demonstrated in serum and CSF of patients with this myelopathy in tropical areas and Japan 314 . In the developing countries, where the HTLV-I infection is endemic, HTLV-I associated myelopathy may be difficult to be recognized due to some diagnostic deficiences. Moreover, the clinical course may be similar to other chronic spinal cord

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Chronic progressive myelopathy associated with HTLV‐I

Cited by 52 publications

References 0 publications

HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings

HAM/TSP: association between white matter lesions on magnetic resonance imaging, clinical and cerebrospinal fluid findings

Oligoclonal immunoglobulins in cerebrospinal fluid during varicella zoster virus (VZV) vasculopathy are directed against VZV

HTLV-I associated myelopathy in patients from Brazil and Iran: neurological manifestations and cerebrospinal fluid findings

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