Conclusion:HTLV-1-neurological damage has followed an ascendant progression beginning at the lumbar spine in the stage of a clinically asymptomatic infection, whereas HAM has affected not only the spine, but also the midbrain.

Background: The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with Human T-cell Lymphotropic Virus type-1 (HTLV-1) infection. Although cognitive impairment has been highlighted in the spectrum of HTLV-1 neurological manifestations, it may go unnoticed in those who do not spontaneously report it. We aimed at evaluating the applicability of a self-perceived memory score (SMS) and the cognitive event-related potential (P300) for the early detection of cognitive impairment in HTLV-1-infected people.Methods: The SMS was measured by a 0-10 visual analog scale combined with a sad-happy faces rating scale. The higher the number, the better was the SMS. The P300 was obtained through an oddball paradigm with a mental counting task. The participants were 15(21,4%) individuals with HAM/TSP, 20(28,6%) HTLV-1-asymptomatic carriers, and 35(50%) seronegative controls.Results: SMS (p<0.001) and P300 latency (p<0.001) got progressively worse from asymptomatic to HAM/TSP. A SMS <7.2 points and a P300 latency >369.0 milliseconds were considered as altered result and indicated cognitive impairment. The HAM/TSP group showed the highest prevalence of altered P300 (80%) and SMS (87%). Interestingly, the asymptomatic group also presented signi cant higher prevalence of altered SMS (60%) and P300 (35%) when compared to controls (<10%). The frequency of cognitive impairment was 16 times higher in the asymptomatic group and 69 times higher in the HAM/TSP group when compared to controls. Conclusion:The use of SMS in the medical consultation was a useful and easy-to-apply method to screen HTLV-1 infected subjects for everyday memory complaints. BackgroundThe rst descriptions of the neurological disease associated with HTLV-1 infections were based on the motor function assessed by mobility and strength disability [1, 2]. The HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP) is a chronic, slow-progressing neurological in ammatory disease that affects approximately 4% of the infected individuals [3, 4]. However, the prevalence of neurological disorders that do not meet the criteria for de nite HAM/TSP, such as urinary disorders, sexual dysfunction and skin lesions, can occur in around 30% of those individuals classi ed as HTLV-1-asymptomatic carriers [4][5][6]. In fact, non-medullary symptoms have been neglected in the HTLV-1 infection [7].Recent evidences have showed that HTLV-1 is related to a complex of neurological manifestations that are not limited to the clinical spectrum of HAM/TSP, affecting all the segments of the central nervous system to a greater or lesser extent [3,[8][9][10][11][12][13][14][15][16][17][18]. In this context, cognitive impairment has been reported as one of the manifestations of the HTLV-1 infection [11,13,[19][20][21][22][23][24]. On the other hand, HAM/TSP remains as the most important neurological disease associated with 26]. Therefore, cognitive impairment can be underdiagnosed and may go unnoticed in those indivi...

PurposeVestibular Myogenic Evoked Potential (VEMP) evaluates vestibulo-ocular and vestibulo-collic reflexes involved in the function of the otolithic organs and their afferent pathways. We compared the results of cervical and ocular VEMP in HTLV-1 associated myelopathy (HAM) and HTLV-1-asymptomatic infection.Participants and methodsThis cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26 asymptomatic carriers) and 26 seronegative controls. The groups were similar regarding age and gender. Participants underwent simultaneous ocular and cervical VEMP. The stimulus to generate VEMP was a low-frequency tone burst sound tone burst, with an intensity of 120 decibels normalized hearing level, bandpass filter from 10 to 1,500 Hertz (Hz), with 100 stimuli at 500 Hz and 50 milliseconds recording time. The latencies of the electrophysiological waves P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP were compared among the groups. The absence or delay of the electrophysiological waves were considered abnormal results.ResultsOcular VEMP was similar among the groups for N10 (p = 0.375) and different for P15 (p≤0.001). Cervical VEMP was different for P13 (p = 0.001) and N23 (p = 0.003). About ocular VEMP, in the HTLV-1-asymptomatic group, normal waves were found in 23(88.5%) individuals; in HAM group, normal waves were found in 7(26.9%). About cervical VEMP, 18(69.2%) asymptomatic carriers presented normal waves and only 3(11.5%) patients with HAM presented normal waves. Abnormalities in both VEMPs were found in 1(3.8%) asymptomatic carrier and in 16(61.5%) patients with HAM.ConclusionNeurological impairment in HAM was not restricted to the spinal cord. The mesencephalic connections, tested by ocular VEMP, have been also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM.

Objective: to analyze the consistency of responses of evaluators and to verify the usability of the perception and analysis of SOLAR (Science of Language and Reading) Methods: a non-experimental descriptive cross-sectional study. Elementary school teachers and undergraduate students of speech therapy and pedagogy participated as the judges. The judges used the SOLAR Scale as an instrument to analyze the reading fluency of twenty audios recorded by elementary school students. Usability comparisons were performed using the Kruskal Wallis test and two-by-two comparisons using the Mann Whitney test. To analyze the consistency of the responses between the judges, the calculation of the interclass correlation coefficient was used. Results: the analysis of the reliability of the answers showed an excellent intraclass correlation coefficient for all the skills of the Scale. As for the usability of the Scale, more than 80% of the participants positively evaluated the assessment. This was verified through the usability questionnaires which confirmed that it was easy to use, with clear guidelines and that users felt comfortable and confident using it. Conclusion: SOLAR obtained good results in reliability and consistency with excellent agreement between the evaluators. These results indicated satisfactory reliability of the SOLAR items and favorable qualitative ratings from users.

Background: The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with Human T-cell Lymphotropic Virus type-1 (HTLV-1) infection. Although cognitive impairment has been highlighted in the spectrum of HTLV-1 neurological manifestations, it may go unnoticed in those who do not spontaneously report it. We aimed at evaluating the applicability of a self-perceived memory score (SMS) and the cognitive event-related potential (P300) for the early detection of cognitive impairment in HTLV-1-infected people. Methods: The SMS was measured by a 0-10 visual analog scale combined with a sad-happy faces rating scale. The higher the number, the better was the SMS. The P300 was obtained through an oddball paradigm with a mental counting task. The participants were 15(21,4%) individuals with HAM/TSP, 20(28,6%) HTLV-1-asymptomatic carriers, and 35(50%) seronegative controls. Results: SMS (p<0.001) and P300 latency (p<0.001) got progressively worse from asymptomatic to HAM/TSP. A SMS <7.2 points and a P300 latency >369.0 milliseconds were considered as altered result and indicated cognitive impairment. The HAM/TSP group showed the highest prevalence of altered P300 (80%) and SMS (87%). Interestingly, the asymptomatic group also presented significant higher prevalence of altered SMS (60%) and P300 (35%) when compared to controls (<10%). The frequency of cognitive impairment was 16 times higher in the asymptomatic group and 69 times higher in the HAM/TSP group when compared to controls. Conclusion: The use of SMS in the medical consultation was a useful and easy-to-apply method to screen HTLV-1 infected subjects for everyday memory complaints.