Differentiation of HAM/TSP from patients with multiple sclerosis infected with HTLV-I

-HTLV-1 is a retrovirus associated with a myriad of clinical conditions, especially hematological and neurological ones. Regarding nervous system diseases, it is of utmost importance to select those cases in which HTLV-1 infection could really be associated. This is particularly true for patients from endemic areas and for HIV-infected patients and drug users, since that these groups are at a higher risk for HTLV infection. This caution in selecting neurological patients for HTLV diagnostic tests is justified by the fact that in some circumstances the seropositivity may merely represent an epiphenomenon. In this paper we enroll some neurological conditions that have been associated with HTLV-1/2 infection in the literature and discuss the real need for HTLV-1/2 diagnostic tests in each one. Because HIV/HTLV-co-infected patients seem to be at an increased risk for neurological diseases development, a special consideration about this matter is also made.KEy WORDs: HTLV, myelopathy, myopathy, peripheral neuropathy, HIV.doenças neurológicas e infecção pelo HTLV-1: quando suspeitar e quando solicitar testes diagnósticos para a infecção pelo HTLV-1Resumo -O HTLV-1 é um retrovírus associado tanto a doenças hematológicas quanto a doenças neurológicas. Em relação às doenças neurológicas, é fundamental que selecionemos aquelas em que de fato a infecção pelo HTLV-1 possa ser a causa. Isto é particularmente verdadeiro nos pacientes oriundos de áreas endêmicas e nos pacientes infectados pelo HIV e usuários de drogas, haja vista que estes grupos são de risco para infecção pelo HTLV. Este cuidado ao selecionarmos aquelas condições neurológicas que merecem ser investigadas com sorologia para o HTLV se justifica pelo fato de que nem sempre podemos afastar uma associação fortuita entre a infecção e a referida doença. Neste artigo, comentaremos sobre algumas condições neurológicas que podem estar associadas com a infecção pelo HTLV-1/2, discutindo a real necessidade de solicitar testes para o diagnóstico da infecção pelo HTLV-1/2 frente a elas. Uma breve consideração sobre a co-infecção HIV/ HTLV será feita no final deste artigo tendo em vista que estes pacientes apresentam um risco aumentado para o desenvolvimento de doenças neurológicas.PALAVRAs-CHAVE: HTLV, mielopatia, miopatia, neuropatia periférica, HIV.The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus and the etiologic agent of both a group of hematological disorders known as Adult T cell leukemia/ lymphoma (ATLL) 1 and a group of neurological conditions known altogether as the HTLV-1 neurological complex 2 , of which the most common is the HTLV-1 associated myelopathy/Tropical spastic paraparesis (HAM/TsP) 3 . Endemic infection with HTLV-1 is now recognized to be worldwide, and is also common in Brazil 4 . The number of people around the world infected with HTLV-1 is estimated as being between 10 to 20 million. There are areas in Japan, sub-saharan Africa, the Caribbean, and south America where more than 1% of the general population is infected. T...

Section: Multiple Sclerosis Patientsmentioning

confidence: 99%

HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection?

Araújo

Leite

Lima

et al. 2009

“…However, TMS might be useful to monitor disease progression and therapeutic measures, mostly at earlier stages of disease, when impaired axonal flow just starts and long before a ceiling effect of degeneration has appeared 28 . Despite the fact that axonal changes happen early in disease in HAM/TSP 49,50 , the demyelination process as well as the clinical course described throughout the years resembles multiple sclerosis 53,54 . MEP abnormalities in paraspinal muscles were found consistently abnormal, the lesion being more bilateral in HAM/TSP compared to multiple sclerosis; however, the small sample of patients investigated precluded advancing conclusions about the paraspinal involvement of HAM/TSP 30,45 .…”

Section: Discussionmentioning

confidence: 99%

“…MEP abnormalities in paraspinal muscles were found consistently abnormal, the lesion being more bilateral in HAM/TSP compared to multiple sclerosis; however, the small sample of patients investigated precluded advancing conclusions about the paraspinal involvement of HAM/TSP 30,45 . In any event, CMCT, and likely, conduction velocity to paraspinal muscles obtained with TMS, may be added to the laboratory investigations suggested elsewhere 9,45,53,54 in helping differentiate these two disorders, mostly in places where they could overlap in the general population [55][56][57][58] .…”

Section: Discussionmentioning

confidence: 99%

The motor evoked potential in aids and HAM/TSP State of the evidence

León-Sarmiento

Elfakhani

Boutros

2009

-Objective: We aimed to better understand the involvement of the corticospinal tract, assessed by non-invasive transcranial stimulation, in order to determine the actual involvement of the motor system in patients with HAM/TSP and AIDS. Method: An exhaustive MEDLINE search for the period of 1985 to 2008 for all articles cross-referenced for "HTLV-I, HTLV-II, HTLV-III and HIV, HIV1, HIV2, evoked potential, motor evoked potential, high voltage electrical stimulation, transcranial magnetic stimulation, magnetic stimulation, corticomotor physiology, motor pathways, acquired immunodeficiency syndrome, AIDS, SIDA, tropical spastic paraparesis, HTLV-I-associated myelopathy, HAM, TSP, and HAM/TSP" were selected and analysed. Results: Eighteen papers published in English, Spanish, Portuguese, French and Japanese were identified. Only the central motor conduction time has been analyzed in seropositive patients to human retroviruses. The investigations done on HAM/TSP support the involvement of the pyramidal tract mainly at lower levels, following a centripetal pattern; in AIDS, such an involvement seems to be more prominent at brain levels following a centrifugal pattern. Conclusion: The central motor conduction time abnormalities and involvement differences of the corticospinal tract of patients with AIDS and HAM/TSP dissected here would allow to re-orient early neurorehabilitation measures in these retroviruses-associated neurodegenerative disorders. Besides this, more sophisticated and sensitive non-invasive corticospinal stimulation measures that detect early changes in thalamocortical-basal ganglia circuitry will be needed in both clinically established as well as asymptomatic patients at times when the fastest corticospinal fibers remain uninvolved.KEY WORDS: AIDS, HAM/TSP, HIV, HTLV-I, transcranial magnetic stimulation, non-invasive transcranial stimulation, pyramidal tract. El potencial evocado motor en SIDA y HAM/PETResumen -Objetivo: Investigar el compromiso del tracto piramidal, evaluado por estimulación trascranial no invasiva, en pacientes afectados por SIDA y HAM/TSP. Método: Se realizó una búsqueda en la base de datos MEDLINE, que abarcó el período de 1985 a 2008; se incluyeron los términos "HTLV-I, HTLV-II, HTLV-III and HIV, HIV1, HIV2, evoked potential, motor evoked potential, high voltage electrical stimulation, transcranial magnetic stimulation, magnetic stimulation, corticomotor physiology, motor pathways, acquired immunodeficiency syndrome, AIDS, SIDA, tropical spastic paraparesis, HTLV-I-associated myelopathy, HAM, TSP, and HAM/ TSP". Resultados: Se obtuvieron 18 artículos publicados en inglés, español, portugués, francés y japonés. El tiempo de conducción central es el único parámetro que se ha estudiado en individuos seropositivos a retrovirus humanos. Las investigaciones hechas en HAM/PET apoyan el compromiso del tracto piramidal, principalmente a nivel dorso-lumbar, de manera centrípeta. En SIDA, el compromiso parece ser mas prominente a nivel cortical, siguiendo un patrón centrifugo. Co...

“…This model aims at clinical aspects starting at the onset of the disease, including cases of oligosymptomatic disturbances, and additional laboratorial findings attesting the presence of anti-HTLV-I virus proteins (by the Western blot (WB) test and/or polymerase chain reaction (PCR)) in the CSF 6 . In endemic areas of HTLV-I infection, the differential diagnosis between myelopathies of unknown origin and HAM/TSP can be difficult, especially in the case of slowly progressive chronic myelopathy, such as the primary progressive type of multiple sclerosis 7,8 . Due to the difficulty in diagnosing HAM/TSP, its progressive and incapacitating nature, and the comorbidity involved, a more detailed review of the subject proved to be justified.…”

Section: Difficulties In Ham/tsp Diagnosismentioning

confidence: 99%

Difficulties in HAM/TSP diagnosis

Slater

Ribeiro

Puccioni-Sohler

2012

The World Health Organization recommends the use of Osame's criterion (1990) for the diagnosis of HTLV-I-associated myelopathy (HAM/TSP). In 2006, a group of neurologists developed a Brazilian criterion that can diagnose HAM/TSP from its onset. OBJECTIVE: It was to test the agreement between both criteria. METHODS: The study included evaluation of clinical and laboratory findings of 35 patients. The ELISA, Western blot and/or polymerase chain reaction was used to search for anti-HTLV-I antibodies. The analysis of agreement was based on the calculation of Kappa. RESULTS: Concordance of 100% (Kappa=1) occurred in cases of "defined" HAM/TSP, but not in patients with "probable" diagnosis. CONCLUSION: The Brazilian criteria was as effective as Osame's criteria for the diagnosis of "defined" HAM/TSP. However, both require more specific biological markers in cerebrospinal fluid for the laboratory diagnosis of probable cases.