ABSTRACT
OBJECTIVE: Tropical Spastic Paraparesis/HTLV-I Associated Myelopathy (TSP/HAM) is a chronic myelopathy, and pain has been mentioned as a frequent sensory symptom in this condition. The authors aimed at analyzing this symptom in a TSP/HAM patients series. METHOD: For this, 46 patients were analyzed considering demographic and clinical characteristics and complaint of pain as to verbal description, time of onset and classification, correlated with the degree of motor disability and type of pain. RESULTS: Among the 46 TSP/HAM patients, 28 (60.8%) complained of pain, predominant in the early phase of the disease. Most of the patients exhibited neuropathic characteristics of pain, correlated with increased motor disability. CONCLUSION: Pain in TSP/HAM patients is a frequent and early symptom, and the neuropathic type is predominant (57.1%) and paralleled with increased incapacitation. The pathogenic involvement of cytokines may possibly be involved in the meaning of this symptom in this condition.
Subject(s)
Pain/etiology , Paraparesis, Tropical Spastic/complications , Cohort Studies , Disability Evaluation , Female , Humans , Male , Pain/classificationABSTRACT
OBJECTIVE: Tropical Spastic Paraparesis/HTLV-I Associated Myelopathy (TSP/HAM) is a chronic myelopathy, and pain has been mentioned as a frequent sensory symptom in this condition. The authors aimed at analyzing this symptom in a TSP/HAM patients series. METHOD: For this, 46 patients were analyzed considering demographic and clinical characteristics and complaint of pain as to verbal description, time of onset and classification, correlated with the degree of motor disability and type of pain. RESULTS: Among the 46 TSP/HAM patients, 28 (60.8 percent) complained of pain, predominant in the early phase of the disease. Most of the patients exhibited neuropathic characteristics of pain, correlated with increased motor disability. CONCLUSION: Pain in TSP/HAM patients is a frequent and early symptom, and the neuropathic type is predominant (57.1 percent) and paralleled with increased incapacitation. The pathogenic involvement of cytokines may possibly be involved in the meaning of this symptom in this condition.
OBJETIVO: A Paraparesia Espástica Tropical/Mielopatia Associada ao HTLV-I (PET/MAH) é uma mielopatia crônica, e a dor tem sido mencionada como um sintoma sensitivo freqüente nessa condição. Os autores objetivam analisar esse sintoma numa série de pacientes com PET/MAH. MÉTODO: Para isso, 46 pacientes foram analisados considerando características demográficas e clínicas, e queixa de dor do ponto de vista da descrição verbal, tempo de início e classificação, correlacionados com o grau de incapacitação motora e o tipo de dor. RESULTADOS: Dentre os 46 pacientes com PET/MAH, 28 (60,8 por cento) se queixavam de dor, predominando na fase inicial da doença. A maioria dos pacientes evidenciou características de dor neuropática, correlacionada com aumento da incapacitação motora. CONCLUSÃO: A dor em pacientes com PET/MAH é um sintoma freqüente e inicial, sendo o tipo neuropático predominante (57,1 por cento) e em paralelo com maior incapacitação. O envolvimento patogênico das citocinas poderá possivelmente estar relacionado com o significado desse sintoma nessa condição clínica.
Subject(s)
Female , Humans , Male , Pain/etiology , Paraparesis, Tropical Spastic/complications , Cohort Studies , Disability Evaluation , Pain/classificationABSTRACT
The Brazilian Ministry of Health (STD and Aids Program) invited specialists to make up an informative guide to deal with HTLV patients. Among the different topics, the neurological aspects associated to HTLV were contemplated. A suspected case should include changes in force and reflexes, distal paresthesiae and autonomic dysfunction. The investigation of such case should be based on the syndrome shown by the patient. For patients with spinal cord syndrome, magnetic resonance imaging or myelography as well as spinal fluid studies should be carried out. For patients with neuropathic or myopathic syndrome, electroneuromyography and CPK dosing should be done, and for those with autonomic syndrome, a search for postural hypotension, ultrasonography of urinary tract and urodynamic studies should be requested. The treatment may be symptomatic (spasticity, neurogenic bladder, intestinal constipation and neuropathic pain) and specific to be carried out in specialized centers.
Subject(s)
Central Nervous System Viral Diseases , Deltaretrovirus Infections , Brazil , Central Nervous System Viral Diseases/diagnosis , Central Nervous System Viral Diseases/therapy , Central Nervous System Viral Diseases/virology , Deltaretrovirus Infections/diagnosis , Deltaretrovirus Infections/therapy , Humans , Paraparesis, Tropical Spastic/diagnosis , Paraparesis, Tropical Spastic/therapy , Paraparesis, Tropical Spastic/virologyABSTRACT
O Ministério da Saúde (Programa DST e Aids) reuniu especialistas para elaborar um guia informativo de manejo do paciente com HTLV. Dentre os diferentes tópicos, foram contemplados os aspectos neurológicos associados à infecção pelo HTLV. Um caso suspeito de doença neurológica associada ao HTLV deve incluir alteração de força e reflexos, parestesias distais e disfunção autonômica. A investigação do caso suspeito deve ser baseada na síndrome exibida pelo paciente. Para o paciente com síndrome medular, deve-se solicitar ressonância magnética da medula ou mielografia, assim como, estudo do líquor. Para o paciente com síndrome neuropática ou miopática, deve-se solicitar eletroneuromiografia e dosagem de CPK, e para aquele com síndrome autonômica, pesquisa de hipotensão postural, ultrassonografia das vias urinárias e estudo urodinâmico. O tratamento pode ser sintomático (espasticidade, bexiga neurogênica, constipação intestinal e dor neuropática) e específico a ser feito em centros especializados.
Subject(s)
Humans , Central Nervous System Viral Diseases , Deltaretrovirus Infections , Brazil , Central Nervous System Viral Diseases/diagnosis , Central Nervous System Viral Diseases/therapy , Central Nervous System Viral Diseases/virology , Deltaretrovirus Infections/diagnosis , Deltaretrovirus Infections/therapy , Paraparesis, Tropical Spastic/diagnosis , Paraparesis, Tropical Spastic/therapy , Paraparesis, Tropical Spastic/virologyABSTRACT
We report on a neuropathological analysis of two cases of TSP/HAM originating from Brazil. These two cases had, respectively, an evolution of 13 and 40 years. The main neuropathological findings consisted of spinal cord atrophy, mainly the lower thoracic cord, diffuse degeneration of the white and grey matter, rare foci of mononuclear and perivascular cuffs, and hyaline hardening of arteriolae. The supraspinal structures were normal, excepting for a slight gliosis in the cerebellum. An analysis on the long evolutive cases as described in the literature is outlined in this study.
Subject(s)
Paraparesis, Tropical Spastic/pathology , Autopsy , Brain/pathology , Female , Humans , Nerve Degeneration/pathology , Spinal Cord/pathologyABSTRACT
We report on a neuropathological analysis of two cases of TSP/HAM originating from Brazil. These two cases had, respectively, an evolution of 13 and 40 years. The main neuropathological findings consisted of spinal cord atrophy, mainly the lower thoracic cord, diffuse degeneration of the white and grey matter, rare foci of mononuclear and perivascular cuffs, and hyaline hardening of arteriolae. The supraspinal structures were normal, excepting for a slight gliosis in the cerebellum. An analysis on the long evolutive cases as described in the literature is outlined in this study
Subject(s)
Humans , Female , Paraparesis, Tropical Spastic , Brain , Nerve Degeneration , Spinal CordABSTRACT
We reviewed the historical, clinical and etiological aspects of the progressive chronic spastic myelopathies of unknown etiology, disserting on the clinical similarities between HTLV-I seropositive and seronegative tropical spastic paraparesis (TSP), as well as focusing on the PCR studies of the seronegative TSP
Subject(s)
Humans , Paraparesis, Tropical Spastic , Diagnosis, Differential , Paraparesis, Tropical Spastic/blood , Paraparesis, Tropical Spastic/diagnosis , Polymerase Chain ReactionABSTRACT
We report on the preliminary clinical and electrophysiological aspects of an in-patient possibly presenting epilepsia partialis continua (Koshevnikov). We discuss the different etiologies and emphasize on the possible idiopathic form in this case
Subject(s)
Humans , Adult , Female , Epilepsia Partialis Continua/physiopathology , Epilepsia Partialis Continua/etiologyABSTRACT
O autor disserta sobre a definiçao de Paraparesia Espástica Tropical desde suas primeiras descriçoes até o envolvimento etiológico do HTLV-1 em parte dos casos. Segundo o autor, o núcleo básico da síndrome inclui uma paraparesia com sinais piramidais (espasticidade e hiperreflexia) e sinais sensitivos e esfincterianos variáveis. A etiologia retroviral pelo HTLV-1 constitui um dos elementos variáveis da condiçao. Ele objetiva prevenir distorçoes conceituais na descriçao dessa condiçao.
Subject(s)
Paraparesis, Tropical Spastic , Paraparesis, Tropical Spastic/etiology , TerminologyABSTRACT
A paraparesia espástica tropical (PET)é mielopatia crônica, observada predominantemente nos trópicos recentemente descoberta ser de origem retroviral (HTLV-I). O objetivo deste estudo foi delinear a evoluçäo histórica de sua descriçäo, denominaçöes e referências etiológicas. A análise histórica revelou que essa condiçäo teve diferentes denominaçöes e a descoberta de sua etiologia retroviral em parte dos casos abriu diversas linhas de investigaçöes e interesse epidemiológico, nos trópicos e no Brasil
