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Tropical spastic paraparesis in Kerala
1Apollo Hospitals, Gream's Lane, Chennai-600006, India.
Abstract:
Tropical Spastic Paraparesis (TSP) is an uncommon myeloneuropathy with an insular geographic distribution. In 1985, Human T-lymphotropic virus type I (HTLV-1) was reported to be a possible etiological factor. We did an epidemiological, clinical and virological study of 25 cases of TSP. They were predominantly young adult men, whose duration of illness ranged from 6 months to 15 years. Difficulty in walking, stiffness of legs and paraesthesia of legs were the main symptoms. None had tuberculosis, syphilis, malnutrition or lathyrism. Pyramidal signs of the lower limbs, upper limbs, posterior column involvement and spinothalamic tract dysfunction were the common signs. Laboratory findings and cerebrospinal fluid analysis were normal in most. Myelograms or MRI were normal in all. Only 1 case repeatedly tested positive for HTLV-1 antibodies. None of his relatives had clinical or virological evidence of TSP or HTLV-1 infection. Based on our study, we could not link HTLV-I infection to TSP in Indian cases. Virological testing for HTLV-I infection by polymerase chain reaction may be a better tool to reveal such an association. Our cases were similar to seronegative spinal spastic paraplegia. A related new retrovirus or an altered immune response to HTLV-1 due to environmental or dietary factors are possibilities which require further exploration.
Insights
This study investigated Tropical Spastic Paraparesis (TSP) in Indian cases, finding no direct link to Human T-lymphotropic virus type I (HTLV-1) infection. Further research into alternative causes like new retroviruses or immune responses is suggested.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Tropical Spastic Paraparesis (TSP) is a rare myeloneuropathy.
- Human T-lymphotropic virus type I (HTLV-1) was previously suspected as an etiological factor for TSP.
Purpose of the Study:
- To investigate the epidemiological, clinical, and virological association between HTLV-1 infection and TSP in Indian patients.
- To explore potential alternative causes for TSP in the absence of a confirmed HTLV-1 link.
Main Methods:
- Conducted an epidemiological, clinical, and virological study of 25 TSP cases.
- Performed clinical examinations, laboratory tests, cerebrospinal fluid analysis, myelograms, MRI, and HTLV-1 antibody testing.
- Considered polymerase chain reaction (PCR) for future virological testing.
Main Results:
- The study involved predominantly young adult men with symptoms including difficulty walking and leg stiffness.
- Most patients had normal laboratory findings, cerebrospinal fluid analysis, myelograms, and MRI scans.
- Only one case tested positive for HTLV-1 antibodies, with no evidence of familial infection.
Conclusions:
- The study could not establish a link between HTLV-1 infection and TSP in the studied Indian population.
- The observed cases resembled seronegative spinal spastic paraplegia.
- Further research is needed to explore potential roles of novel retroviruses or altered immune responses due to environmental/dietary factors.
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