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

Puccioni-Sohler, Márzia; Kitze, Bernd; Felgenhauer, K.

doi:10.1590/s0004-282x1995000200005

Cited by 11 publications

(11 citation statements)

References 14 publications

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“…These patients had no symptoms of measles, rubella or zoster infections. In three HAM/TSP patients, no intrathecal HTLV-I-antibody synthesis was detectable (Table 2) despite elevated HTLV-I antibody titres in blood 14 .…”

Section: Resultsmentioning

confidence: 97%

“…HAM/TSP does not exhibit a MRZ reaction, but as most other chronic infectious diseases, a local anti-HTLV-I response with ASI values above 1.5 (ASI = antibody specificity index). There is no correlation between CSF immunoglobulin or antibody levels and the clinical symptoms 14,15 . The CSF levels depend much more on the localization of the inflammatory lesions than on their inflammatory, destructive activities 2,3 .…”

Section: Discussionmentioning

confidence: 98%

“…Five patients with MS as well five with epilepsy were Caucasian, one with MS was African descendent and one with epilepsy was of mixed ethnic origin. Epidemiological and clinical data together with detailed data of CSF diagnosis have been reported elsewhere 14 .…”

Section: Methodsmentioning

confidence: 99%

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The value of csf analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis

Puccioni-Sohler

Kitze

Felgenhauer

et al. 1995

Arq. Neuro-Psiquiatr.

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SUMMARY -Cerebrospinal fluid (CSF) and serum of 17 patients with HAM/TSP (HTLV-I associated myelopathy/ tropical spastic paraparesis), six with multiple sclerosis and six with idiopathic epilepsy (non inflammatory control) from Brazil were analysed for the presence of intrathecal synthesis of virus-specific antibodies against measles, rubella, varicella zoster virus and herpes simplex virus by enzyme-linked immunosorbent assay (ELISA). All HAM/TSP and multiple sclerosis cases had an intrathecal immune response (oligoclonal IgG). In HAM/TSP, only 1/17 case showed a polyspecific intrathecal immune response against measles and rubella virus. In multiple sclerosis, specific antibodies against measles and rubella (MRZ response) were observed in all patients but not in the control with idiopathic epilepsy. The diagnostic and theoretical relevance of mono-and polyspecific immune responses is discussed for these chronic neurological diseases. KEY WORDS: HTLV-I, HAM/TSP, cerebrospinal fluid, antibody indexValor da análise do LCR para o diagnóstico diferencial de mielopatia associada ao HTLV-I e esclerose múltipla RESUMO -Amostras de líquido cefalorraquidiano (LCR) e soro de 17 pacientes brasileiros com HAM/TSP, seis com esclerose múltipla e seis com epilepsia idiopática (controle não-inflamatório) foram analisadas para a presença de anticorpos para os vírus do sarampo, rubéola, varicela zoster e herpes simples pelo método de ELISA. Todos os casos de HAM/TSP e esclerose múltipla tinham resposta imune intratecal (IgG oligoclonal). Somente 1/17 casos de HAM/TSP apresentavam resposta imune poliespecifica intratecal para sarampo e rubéola. Anticorpos específicos para sarampo e rubeola (resposta MRZ) foram observados em todos os pacientes com esclerose múltipla, mas não nos controles com epilepsia idiopática. A relevância das respostas poliespecifica e monoespecifica é discutida para essas doenças neurológicas crônicas. PALAVRAS-CHAVE: HTLV-I, HAM/TSP, líquido cefalorraquidiano, índice de anticorpos.The sensitive detection of intrathecally synthesized antibodies increased the relevance of CSF analysis for diagnosis of neurological diseases 17 . The sucessful concepts for discrimination of blood derived and brain derived CSF fractions 16 of immunoglobulin could be extended to the detection of brain defined specific antibodies exceeding the theoretical upper concentration of blood derived antibody species in CSF. An immune response against virus antigens within the central nervous system (CNS) has been demonstrated in different neurological diseases 1 " 4 -6,7 . This reaction may be

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

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The value of csf analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis

Puccioni-Sohler

Kitze

Felgenhauer

et al. 1995

Arq. Neuro-Psiquiatr.

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“…28,29 The well-known variability in the progression of the disease may in part explain the lack of significant differences between groups regarding the duration of the disease. 28,30,31 Thus, duration does not necessarily implies greater disability.…”

Section: Discussionmentioning

confidence: 99%

Disability profile of patients with HTLV-I-associated myelopathy/tropical spastic paraparesis using the Functional Independence Measure (FIM™)

Franzoi

Araújo

2004

Spinal Cord

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Study design: Survey. Objective: To determine the disability profile of a group of patients with human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), using the Functional Independence Measure (FIMt) to identify the most affected functional areas. Setting: Reference center for HTLV Rio de Janeiro, Brazil. Methods: A total of 72 patients (49 female and 23 male), consecutively referred by tertiary care centers, were assessed using the FIMt. Results: The average FIMt score was 108 (712 SD) ranging from 58 to 122. The lowest items scores were obtained in locomotion and bladder management. When divided into two groups (above, and below or equal to the average score), there were significant differences (Po0.05) in age at time of assessment, in the degree of muscular power and in low back pain. There were no significant differences in terms of age of onset and duration of the disease. Conclusions: The most affected areas in FIMt motor items were locomotion (walk and stairs) and bladder management. Age, strength in lower limbs and low back pain interfere with functional activities in patients with HAM/TSP. The duration of the disease is not a significant factor for patient disabilities. The goals of rehabilitation in HAM/TSP patients should target the modifiable factors, such as pain, strength and the neurogenic bladder.Spinal Cord (2005) 43, 236-240.

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“…A verificação de anticorpos totais ou específicos no LCR não permite demonstrar se estes são produzidos no SNC ou provêm do sangue pela passagem da barreira hemato-LCR (5,10,16) . Para tal é necessário relacionar os valores do LCR com o soro, considerando a função da barreira hemato-LCR.…”

Section: Figura 2 -unclassified

Diagnóstico laboratorial da mielopatia associada ao HTLV-I: métodos para análise do líquido cefalorraquidiano

Gonçalves¹,

Ribeiro²,

Sá³

et al. 2009

J. Bras. Patol. Med. Lab.

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; Marzia Puccioni-Sohler 4O vírus linfotrópico de células T humanas do tipo I (HTLV-I) pode causar uma doença neurológica inflamatória, crônica e incapacitante, que acomete a medula espinhal, denominada mielopatia associada ao HTLV-I/paraparesia espástica tropical (PET/MAH). A verificação de anticorpos da classe G (IgG) anti-HTLV-I no soro e no líquido cefalorraquidiano (LCR) representa importante parâmetro para o diagnóstico laboratorial da PET/MAH. Objetivo: Avaliação crítica dos métodos utilizados para verificação da presença e da produção intratecal de anticorpos totais e anti-HTLV-I no LCR para o diagnóstico de PET/MAH. Método: Realizou-se uma revisão sistemática de artigos da literatura médica, usando-se palavras-chave da língua inglesa como cerebrospinal fluid, intrathecal synthesis of antibodies, HTLV-I, HAM/TSP. As bases de dados utilizadas incluíram Pubmed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), MEDlars onLINE (Medline) e Cochrane Library. Resultado: Foram selecionados 14 artigos: cinco relacionados com a presença do anticorpo IgG específico no LCR; nove sobre síntese intratecal de anticorpos totais (IgG ou IgG/IgA/IgM) e específicos anti-HTLV-I (IgG ou IgM). Discussão: O estudo isolado da presença de anticorpo IgG anti-HTLV-I no LCR não discrimina a fração produzida no sistema nervoso central (SNC), possui baixa especificidade (40%) para o diagnóstico de PET/MAH. A demonstração da síntese intratecal de anticorpos IgG anti-HTLV-I possui maior relevância por suas elevadas especificidade (89%) e sensibilidade (83%). Entre os métodos para a avaliação da síntese intratecal de anticorpo específico, destaca-se o índice de IgG anti-HTLV-I, segundo Reiber e Felgenhauer (18) , o qual se baseia no teste do ensaio imunossorvente ligado à enzima (ELISA), com análise simultânea do LCR e do soro. Outros estudos utilizam pequenas amostragens e não demonstram sensibilidade e especificidade no teste do LCR. Apenas um trabalho possui análise estatística. Conclusão: Existe a necessidade da padronização de métodos para o diagnóstico imunológico do LCR na PET/MAH, com base em testes de elevadas sensibilidade e especificidade. Reiber & Felgenhauer (1987) abstract resumo The human T-cell lymphotropic virus type I (HTLV-I) may cause HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP), an incapacitating chronic inflammatory disease of the spinal cord. The detection of IgG anti-HTLV-I antibodies in the serum and cerebrospinal fluid (CSF) has been an important parameter for the laboratorial diagnosis of HAM/TSP. Objective: critical evaluation of the methods applied to detect the presence and intrathecal production of total antibodies and anti-HTLV-I in the CSF for the diagnosis of HAM/TSP. Methods: We performed a systematic review of medical articles by using the key words: "cerebrospinal fluid, intrathecal synthesis of antibodies, HTLV-I associated myelopathy, HTLV-I, HAM/TSP". The used databases included: PubMed, Lilacs, Medline and Cochrane Library. Results: A total of 14 artic...

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

Cited by 11 publications

References 14 publications

The value of csf analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis

The value of csf analysis for the differential diagnosis of HTLV-I associated myelopathy and multiple sclerosis

Disability profile of patients with HTLV-I-associated myelopathy/tropical spastic paraparesis using the Functional Independence Measure (FIM™)

Diagnóstico laboratorial da mielopatia associada ao HTLV-I: métodos para análise do líquido cefalorraquidiano

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