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.

Dr. Oger's update of 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 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. Dr. Oger 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 recent progress made in the biology and epidemiology as well as clinical and MRI phenotyping. Unfortunately, treatment of the disease has remained disappointing.

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 inflammatory demyelinating myelopathies.
  • It clinically looks like spinal cord primary progressive multiple sclerosis, and one must think about it as a differential; otherwise, it will be missed. Serology 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.