HTLV-1 associated myelopathy

Introduction
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By Joel Oger MD

HTLV-1 associated myelopathy is also known as or subsumes Tropical spastic paraparesis. -ed.

The author’s update of this article on HTLV-1 associated myelopathy is an essential tool for physicians and virologists alike. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) is essentially a disease of persons of Caribbean and Japanese origins, which has spread among a number of other ethnic groups. Through horizontal transmission, HTLV-1 infection has become more frequent among Caucasians and, thus, HAM/TSP. The author expands on the criteria for diagnosis and stresses their practical value. He brings to the world’s attention the fact that HTLV-1 pandemy is affecting Canadian Natives of the Northwest Pacific and that the disease is starting to appear among Caucasians. The author defines the similarities and differences between primary progressive multiple sclerosis and HTLV-1 associated myelopathy. He describes the main features of the disease, highlighting the progress made in the biology, epidemiology, and clinical as well as MRI phenotyping. Unfortunately, treatment of the disease has remained disappointing. His clinical experience of the disease, bench work, and insights from many scientific publications will benefit clinicians faced with diagnosing and treating this virally induced inflammatory myelopathy.

Key points

  • HTLV-I associated myelopathy is a retroviral disease specific to certain ethnic groups and transmitted in a manner similar to HIV. It is the model of virally induced inflammatory demyelinating myelopathies.
  • Clinically it looks like spinal cord primary progressive multiple sclerosis, and one must think about it as a differential; otherwise, it will be missed. Serology and PCR will make the diagnosis.
  • The evolution is progressive and leads to disability and death over a matter of years to decades. There is no effective treatment.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
References cited
Contributors