Effect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy

Buell, Kevin G; Puri, Aiysha; Demontis, Maria Piera; Short, Charlotte-Eve; Adonis, Adine; Haddow, Jana; Martin, Fabiola; Dhasmana, Divya; Taylor, Graham P.

doi:10.1371/journal.pone.0152557

Cited by 12 publications

(5 citation statements)

References 47 publications

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“…Thus, galvanic-VEMP is more appropriate to evaluate the central vestibular pathway and the spinal cord disorders [ 15 , 16 , 35 ]. Taking into consideration that galvanic-VEMP stimulates the entire spinal cord and that HAM is a motor myelopathy that starts at the thoracic spine and slowly progresses upward in the spine, the galvanic-VEMP with the response recorded from the inferior members may be an interesting tool for the early diagnosis of HAM [ 30 , 36 ] and for the following-up of these patients in case of future therapeutic strategies [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation may reveal subclinical alterations in human T-cell lymphotropic virus type 1-associated myelopathy

et al. 2018

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BackgroundVestibular-evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) evaluates the motor spinal cord and identifies subclinical myelopathies. We used galvanic-VEMP to compare spinal cord function in individuals infected with human T-cell lymphotropic virus type 1 (HTLV-1) from asymptomatic status to HTLV-1-associated myelopathy (HAM).Methodology/Principal findingsThis cross-sectional study with 122 individuals included 26 HTLV-1-asymptomatic carriers, 26 individuals with possible HAM, 25 individuals with HAM, and 45 HTLV-1-seronegative individuals (controls). The groups were similar regarding gender, age, and height. Galvanic stimuli (duration: 400 ms; intensity: 2 mA) were applied bilaterally to the mastoid processes and VEMP was recorded from the gastrocnemius muscle. The electromyographic parameters investigated were the latency and amplitude of the short-latency (SL) and medium-latency (ML) responses. While SL and ML amplitudes were similar between groups, SL and ML latencies were delayed in the HTLV-1 groups compared to the control group (p<0.001). Using neurological examination as the gold standard, ROC curve showed an area under the curve of 0.83 (p<0.001) for SL and 0.86 (p<0.001) for ML to detect spinal cord injury. Sensibility and specificity were, respectively, 76% and 86% for SL and 79% and 85% for ML. Galvanic-VEMP disclosed alterations that were progressive in HTLV-1-neurological disease, ranging from SL delayed latency in HTLV-1-asymptomatic carriers, SL and ML delayed latency in possible HAM group, to absence of VEMP response in HAM group.Conclusions/SignificanceThe worse the galvanic-VEMP response, the more severe the myelopathy. Galvanic-VEMP alteration followed a pattern of alteration and may be a prognostic marker of progression from HTLV-1-asymptomatic carrier to HAM.

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Section: Discussionmentioning

confidence: 99%

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation may reveal subclinical alterations in human T-cell lymphotropic virus type 1-associated myelopathy

et al. 2018

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“…However, this medication is seldom used because it is not highly efficient [6]. Although data are limited, corticosteroids are most commonly used to maintain motor function by suppressing inflammation [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Corticosteroid Therapy for HTLV-1-Associated Myelopathy: A Randomized Controlled Trial (HAMLET-P)

Yamauchi

Tanabe

Sato

et al. 2022

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Corticosteroids are most commonly used to treat HTLV-1-associated myelopathy (HAM); however, their clinical efficacy has not been tested in randomized clinical trials. This randomized controlled trial included 8 and 30 HAM patients with rapidly and slowly progressing walking disabilities, respectively. Rapid progressors were assigned (1:1) to receive or not receive a 3-day course of intravenous methylprednisolone in addition to oral prednisolone therapy. Meanwhile, slow progressors were assigned (1:1) to receive oral prednisolone or placebo. The primary outcomes were a composite of ≥1-grade improvement in the Osame Motor Disability Score or ≥30% improvement in the 10 m walking time (10 mWT) at week 2 for rapid progressors and changes from baseline in 10 mWT at week 24 for slow progressors. In the rapid progressor trial, all four patients with but only one of four without intravenous methylprednisolone achieved the primary outcome (p = 0.14). In the slow progressor trial, the median changes in 10 mWT were −13.8% (95% CI: −20.1–−7.1; p < 0.001) and −6.0% (95% CI: −12.8–1.3; p = 0.10) with prednisolone and placebo, respectively (p for between-group difference = 0.12). Whereas statistical significance was not reached for the primary endpoints, the overall data indicated the benefit of corticosteroid therapy. (Registration number: UMIN000023798, UMIN000024085)

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“…[31][32][33][34] A retrospective study of 26 patients receiving a three-day course of 1 g IV methylprednisolone was associated with a significant improvement in pain in patients with HAM but with limited effect on gait with no benefit apparent four weeks after therapy. 35 Recent work from Japan shows initial promising results using the anti-CCR4 monoclonal antibody, mogamulizumab. 36 Physiotherapy also plays an important role in assessing disease progression and response to treatment.…”

Section: Overview Of Treatment Modalities For Ham and Atllmentioning

confidence: 99%

Emerging sexually transmitted viral infections: Review of human T-lymphotropic virus-1 disease

Caswell

Manavi

2020

Int J STD AIDS

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Human T-lymphotropic virus-1 is a preventable sexually transmitted infection. In the majority of people it is asymptomatic, remaining undiagnosed and thereby contributing to its silent transmission. When it does manifest it causes significant morbidity and mortality. This review summarises the existing evidence for its role in sexual transmission and offers suggestions for those working in the area of sexual health. This is the third part of a series looking at novel sexually transmitted infections.

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Effect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy

Cited by 12 publications

References 47 publications

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation may reveal subclinical alterations in human T-cell lymphotropic virus type 1-associated myelopathy

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation may reveal subclinical alterations in human T-cell lymphotropic virus type 1-associated myelopathy

Efficacy of Corticosteroid Therapy for HTLV-1-Associated Myelopathy: A Randomized Controlled Trial (HAMLET-P)

Emerging sexually transmitted viral infections: Review of human T-lymphotropic virus-1 disease

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