Proposal for Diagnostic Criteria of Tropical Spastic Paraparesis/HTLV-I-Associated Myelopathy (TSP/HAM)

Abstract

After the first description of TSP/HAM in 1985 and the elaboration of WHO's diagnostic criteria in 1988, the experience of the professionals in this field has increased so that a critical reappraisal of these diagnostic guidelines was considered timely. Brazilian neurologists and observers from other countries met recently to discuss and propose a modified model for diagnosing TSP/HAM with levels of ascertainment as definite, probable, and possible, according to myelopathic symptoms, serological findings, and/or detection of HTLV-I DNA and exclusion of other disorders.

O vírus linfotrópico de células T humanos tipo 1 (HTLV-1): Quando suspeitar da infecção?

“…33 A team of specialists have developed diagnostic criteria for classifying HAM/TSP as definite, probable or possible. 34 Diagnosis of neurological diseases associated with HTLV starts from an initial diagnosis of HTLV infection, confirmed by serological and/or molecular methods in peripheral blood, combined with the presence of one or more of the neurological syndromes mentioned so far and after differential diagnosis with other causes of myelopathy: compressive processes (tumoral, spondylotic), deficiencies (vitamin B12 and folate), toxicity (alcoholism), vascular/metabolic causes (Diabetes mellitus, uremia and thyroid dysfunctions), autoimmunity (multiple sclerosis, connective tissue diseases, paraneoplastic conditions and others), infections and parasites (syphilis, HIV, schistosomiasis) and hereditary (adrenomyeloneuropathies, hereditary spastic paraparesis, Charcot-Marie-Tooth disease and others). 34 The most common findings in cerebrospinal fluid are discrete lymphocytic pleocytosis (≤ 50 cells/mm 3 ) and mildly to moderately elevated protein, observed in around one half of patients.…”

In vivo fluctuation of Tax, Foxp3, CTLA-4, and GITR mRNA expression in CD4+CD25+ T cells of patients with human T-lymphotropic virus type 1-associated myelopathy

“…We confirmed HTLV-1 infection by immunofluorescence and PCR assays (18). The diagnosis of HAM/TSP was made according to the World Health Organization guidelines (19). Other known causes (i.e., multiple sclerosis, spinal cord compression) of progressive spastic paraparesis were excluded according to clinical presentation and according to clinical, neurophysiological, radiological, immunological, and cerebrospinal fluid cytochemical studies (20).…”

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

“…This pain, which occasionally can be very disabling, has a combination of neuropathic and mechanical features 31 . For a more detailed account of clinical features and diagnostic guidelines for HAM/TsP the reader is referred to other sources 2,32 .…”