Sensory Dysfunction in HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis

We performed a comprehensive clinical and neurophysiological evaluation of function of the large- and small-caliber afferent pathways in 29 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Sensory symptoms, particularly cutaneous paresthesias, were present in 11 (37.9%) patients. On examination, a mild distal impairment of vibration and sense of position were found in 14 (48.2%) and 5 (17.2%) patients, respectively. Ten (34.4%) patients had distal tactile hypoesthesia and 7 (24.1%) presented pinprick hypoesthesia. Quantitative somatosensory thermotest showed cold hypoesthesia in 58.6% of patients. Nerve conduction studies and electromyography were normal. Tibial somatosensory evoked potentials were abnormal in 88.5% of patients. All of the sensory abnormalities found were restricted to sensations carried by myelinated (A-beta and A-delta) fibers. Unmyelinated C fibers mediating warm sensation and thermal pain appeared unimpaired. Our findings indicate that the sensory dysfunction in HAM/TSP patients is probably due to a lesion restricted to the central nervous system.

[1]  F. Araya,et al.  Clinical and Neuropathological Study of Six Patients with Spastic Paraparesis Associated with HTLV‐I: An Axomyelinic Degeneration of the Central Nervous System , 1997, Journal of neuropathology and experimental neurology.

[2]  K. Arimura,et al.  Study of lower limb somatosensory evoked potentials in 96 cases of HTLV-I-associated myelopathy/tropical spastic paraparesis , 1996, Journal of the Neurological Sciences.

[3]  K. Hashimoto,et al.  Phylogenetic subtypes of human T-lymphotropic virus type I and their relations to the anthropological background. , 1994, Proceedings of the National Academy of Sciences of the United States of America.

[4]  J. Ochoa,et al.  The triple cold syndrome. Cold hyperalgesia, cold hypoaesthesia and cold skin in peripheral nerve disease. , 1994, Brain : a journal of neurology.

[5]  W. Wachsman,et al.  Peripheral nerve lesions in HTLV‐I associated myelopathy (HAM/TSP) , 1993, Muscle & nerve.

[6]  F. Araya,et al.  Progressive spastic paraparesis associated with human T-cell leukemia virus type I (HTLV-I). , 1992, Internal medicine.

[7]  J. Ochoa,et al.  Quantitative somatosensory thermotest. A key method for functional evaluation of small calibre afferent channels. , 1992, Brain : a journal of neurology.

[8]  R. Kakigi,et al.  Physiological functions of the ascending spinal tracts in HTLV-I-associated myelopathy (HAM). , 1992, Electroencephalography and clinical neurophysiology.

[9]  日沼 頼夫,et al.  Advances in adult T-cell leukemia and HTLV-I research , 1992 .

[10]  I. Maruyama,et al.  HTLV-I-associated myelopathy (HAM): epidemiology, clinical features, and pathomechanism , 1992 .

[11]  F. Araya,et al.  Evoked potential abnormalities in progressive spastic paraparesis associated to HTLV‐1 , 1991, Acta neurologica Scandinavica.

[12]  A. Bhigjee,et al.  Myelopathy associated with human T cell lymphotropic virus type I (HTLV-I) in natal, South Africa. A clinical and investigative study in 24 patients. , 1990, Brain : a journal of neurology.

[13]  M. Watanabe,et al.  Demyelinating changes in sural nerve biopsy of patients with HTLV‐I‐associated myelopathy , 1990, Neurology.

[14]  D. Gajdusek,et al.  [HTLV-I retrovirus in Chile: study on 140 neurological patients]. , 1990, Revista medica de Chile.

[15]  J. Ochoa,et al.  Sensations conducted by large and small myelinated afferent fibres are lost simultaneously under compression-ischaemia block. , 1989, Acta physiologica Scandinavica.

[16]  E. Torebjörk,et al.  Central suppression of cold-induced C fibre pain by myelinated fibre input , 1989, Pain.

[17]  M. Newton,et al.  Tropical spastic paraparesis and human T cell lymphotropic virus type 1 in the United Kingdom. , 1989, Brain : a journal of neurology.

[18]  D. Gajdusek,et al.  HTLV-I POSITIVE SPASTIC PARAPARESIS IN A TEMPERATE ZONE , 1989, The Lancet.

[19]  C. Lacroix,et al.  Inflammatory lesions of peripheral nerve in a patient with human T‐lymphotropic virus type I‐associated myelopathy , 1988, Annals of neurology.

[20]  R. Kakigi,et al.  Multimodality evoked potentials in HTLV-I associated myelopathy. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[21]  J. Sninsky,et al.  Detection of human T-cell lymphoma/leukemia virus type I DNA and antigen in spinal fluid and blood of patients with chronic progressive myelopathy. , 1988, The New England journal of medicine.

[22]  R. Garruto,et al.  Tropical spastic paraparesis in colombia , 1988, Annals of neurology.

[23]  K. Arimura,et al.  Clinical electrophysiologic studies of HTLV-I-associated myelopathy. , 1987, Archives of neurology.

[24]  S. Izumo,et al.  Chronic progressive myelopathy associated with elevated antibodies to human T‐lymphotropic virus type I and adult T‐cell leukemialike cells , 1987, Annals of neurology.

[25]  Recommended Standards for Short‐Latency Somatosensory Evoked Potentials , 1986 .

[26]  Jun Kimura,et al.  Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice , 1983 .

[27]  H. Fruhstorfer,et al.  Method for quantitative estimation of thermal thresholds in patients. , 1976, Journal of neurology, neurosurgery, and psychiatry.