Tropical spastic paraparesis: a neuroepidemiological study in Colombia

A geographic isolate of tropical spastic paraparesis (TSP) in Tumaco, Colombia, is described. Fifty confirmed cases were identified (29 men, 21 women) with an estimated prevalence ratio of 98 cases per 100,000 population. Patients with identified cases ranged in age from 24 to 75 years (mean, 46.5). TSP begins with burning feet, leg stiffness, spastic bladder, and, in men, impotence. Patients exhibited leg weakness, spasticity, hyperreflexia, and scissoring gait. Babinski, Chaddock, and Hoffmann signs could be elicited. Ankle reflexes and vibratory sensation of the feet were decreased. Intellectual function, coordination, and cranial nerves remained normal. TSP is a slowly progressive disorder but so far there have been no deaths from it. Forty cases in this report began between 1971 and 1980; the earliest documented case began in 1952. Living conditions and occupations of the patients were typical for the region. Yaws had occurred in 74% of confirmed cases. No likely etiological neurotoxic or nutritional factors were identified. TSP also has been described in India, Africa, the Seychelles, and Jamaica.