Two Babinski signs in seropositive (HAM) and seronegative tropical spastic paraparesis

Abstract

-Tropical spastic paraparesis (TSP) may or may not be associated to HTLV-I antibodies and is usually characterized by clinical and pathological spinal cord abnormalities at thoracic levels. We present here five Brazilian patients who had typical chronic idiopatic spastic paraparesis; two of them were HTLV-I seropositive (HAM) and three HTLV-I seronegative (TSP) -associated-myelopathy. Three out of these five patients also displayed clinical supraspinal involvement, indeed, platysma muscle hypotrophy or atrophy (the Babinski plus sign). These findings support the view that clinical involvement in HAM and TSP is wider than the spinal cord abnormalities usually considered. Possible non-infectious co-factors (e.g., mycotoxins) may be involved in disease pathogenesis in a multistep process of viruses, toxins and environment which may account for serological differences found in this group of patients. KEY WORDS: HAM, TSP, Babinski plus sign, mycotoxins, neurorehabilitation. dos signos de Babinski en pacientes con paraparesia espástica tropical seropositiva (HaM) y seronegativaResumen -La paraparesia espástica tropical (PET), puede o no estar asociada con anticuerpos contra el HTLV-I y se caracteriza, usualmente, por alteraciones clínicas y patológicas a nivel de region dorso-lumbar de la medula espinal. Presentamos cinco pacientes brasileros, quienes tuvieron hallazgos típicos de paraparesia espástica crónica idiopática; dos de ellos tuvieron (HAM) y tres no tuvieron (TSP) anticuerpos, en el suero, contra el HTLV-I. En tres pacientes se encontró hipotrofia o atrofia del músculo platisma (signo de Babinski plus), demostrando que el compromiso clínico en pacientes con HAM y TSP se extiende más allá de la médula espinal torácica. Cofactores (por ejemplo, micotoxinas) podrían estar involucrados en la patogénesis de esta enfermedad, en una interacción compleja de virus, toxinas y medio ambiente, lo cual explicaría las diferencias serológicas encontradas en este grupo de pacientes.PALABRAS CLAVES: HAM,TSP, signo de Babinski plus, neurorehabilitación.

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

“…However, some patients debut with the disease at the cervical spinal cord level, leaving still unanswered the issue of whether this is a primary or secondary finding in the disease process 8,51 . The lack of a relationship of MEP abnormal findings with "chronic" but not with "moderate" involvement, suggested a critical point of degeneration of neural pathways involved with motor responses in HAM/TSP 28 .…”

“…Shortly following, it was recognized that these disorders were the same clinical entity 6 . Over the years, it has been increasingly recognized that the neural involvement of HAM/TSP is more widespread than initially thought, reaching supraspinal areas of the central nervous system (CNS) [7][8][9][10][11][12] . HIV, on the other hand, has been linked to a number of pathologies, most of which are considered due to opportunistic infections associated with different clinical pictures of immunodeficiency, neural involvement being an important aspect at the cortical and subcortical levels 2,3,13 .…”