Discrepancy, coincidence or evidence in chronic idiopathic spastic paraparesis throughout the world: a meta-analysis on 2811 patients

Abstract

-HTLV-I has been associated with a chronic idiopatic spastic paraparesis (CHISPA) in man; however, a complete understanding of this association is still debated. We selected the most comprehensible papers on this topic between 1985 and 1996, and found that 1261 out of 2811 patients (44.9%) reported, throughout the world, were HTLV-I positive. The mean age was 39.5 years and there was a female predominance of 1.9:1. These results do not exclude the causality of HTLV-I as a germen associated to CHISPA; however, other causes (e.g., toxic, immunosuppressors) must be considered as participating in the multistep neurodegeneration observed in CHISPA throughout the world.KEY WORDS: HTLV-I, spastic paraparesis, meta-analysis, retrovirus, environmental cofactors.Discrepância, coincidência ou evidência em paraparesia espástica idiopática crônica no mundo: uma metaanálise de 2811 pacientes RESUMO -O retrovirus HTLV-1 tem sido associado a paraparesia espástica idiopática crônica (PEIC) no homem; contudo uma compreensão completa dessa associação é motivo de debate. Selecionamos os estudos mundiais mais expressivos sobre esse assunto no período de 1985 a 1996 e verificamos que 1261 dos 2811 (44,9%) dos pacientes relatados eram HTLV-1 positivos. A média de idade era de 39,5 anos com predomínio feminino de 1,9:1. Estes resultados não excluem a causalidade do HTLV-1 como um germe associado a PEIC em todo o mundo.PALAVRAS-CHAVE: HTLV-I, paraparesia espástica, meta-análise, retrovirus, cofatores ambientais.Almost a century ago, Strachan described a type of neuropathy from the West Indies 51 , and since then different reports resembling Strachan's description have been published throughout the world in which the condition is referred to as tropical spastic paraparesis (TSP) 32 . Although the main foci of TSP patients were initially described in tropical places such as Caribbean countries, Africa and South India 3 -6 -12,13 -32 -45 , there were also occasional reports from temperate countries such as Chile and Japan 4,37 . We also found, some years ago, an unusual amount of patients who either lived or were born around Southwestern Colombia and presented a Chronic Idiopathic Spastic Paraparesis(CHISPA) which was similar to TSP and which is described dsewhere 42 -61 " 65 .

Myeloma Presenting as Paraparesis: A Case Report

“…HAM/TSP is a slowly progressive myelopathy characterized by spastic lower limb weakness or paraparesis, hyperactive reflexes, and sphincter dysfunction [10]. A significant proportion of TSPs is associated with HTLV-I while the rest remain idiopathic or at least HTLV-I seronegative [11]. Neurolathyrism on the other hand is a neurologic disorder caused by excessive ingestion of Lathyrus species.…”

Human T-lymphotropic virus type 1–associated myelopathy/tropical spastic paraparesis: Viral load and muscle tone are correlated

“…Of the estimated 10 to 20 million people worldwide infected with human T-cell lymphotropic virus type 1 (HTLV-1), approximately 3000 are recognized as having HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) (de The and Bomford, 1993;Leon et al, 1997;Osame, 1999). The lifetime incidence of HAM/TSP in HTLV-1-infected people is between 0.25% and 2.4% (Kaplan et al, 1990;Maloney et al, 1998;Murphy et al, 1997).…”