Low-back pain in HTLV-I-associated myelopathy/tropical spastic paraparesis: nociceptive or neuropathic?

STUDY DESIGN: Cross-sectional. OBJECTIVES: To describe characteristics of low-back pain in human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients and to identify its neuropathic and/or non-neuropathic pain components. SETTING: A reference center for the care of patients with HAM/TSP in Rio de Janeiro, Brazil. METHODS: A total of 90 patients with HAM/TSP referred by tertiary care centers were consecutively assessed. The patients were submitted to a clinical protocol that included Visual Analogue Scale (VAS), Timed Up and Go Test, Bodily Pain Domain of the Short Form 36 Health Status Questionnaire, Douleur Neuropathique 4 Questions (Neuropathic Pain 4 Questions) (DN4) and McGill Pain Questionnaire. RESULTS: The prevalence of low-back pain in the studied sample was 75.5%; pain interferes with physical functioning and worsens with movement and physical effort. It can be relieved by analgesics and rest. Average pain intensity was 51.2 mm on VAS and 1.72 on DN4. The most frequent words used to describe low-back pain were throbbing, burning, jumping and aching. Surprisingly, 32.4% patients pointed the lower extremities as the most painful and used different descriptors. The most common drugs used were analgesics, nonsteroidal anti-inflammatory drugs and tricyclic antidepressants. CONCLUSIONS: Low-back pain in HAM/TSP patients has mainly nociceptive characteristics. Conversely, descriptors for lower extremities pain suggest a neuropathic origin.

Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP).

STUDY DESIGN: Cross-sectional. OBJECTIVES: The aim of this survey is to describe the disability profile in a group of tropical spastic paraparesis/HTLV-I-associated myelopathy patients, identifying the requirements for community ambulation. SETTING: Tertiary care unit, Rio de Janeiro, Brazil. METHODS: Seventy-two patients were assessed (49 female and 23 male), referred by tertiary care centers, when a clinical protocol was applied. RESULTS: The sample had an average age of 40 years and an average of 137 months of duration of the disease. The most prevalent aspects of disability found were in gait and sphincter control areas. A total of 72% of the patients were community ambulators and 17% were restricted to wheel chair. Age, strength and low-back pain interfere in activities of daily living (P<0.05). A positive correlation was found between community ambulation and the knee extensors (r=0.80) and ankle plantar flexors (r=0.74). Strength, age, low-back pain, duration of disease, asymmetric onset of the symptoms and spasticity interfered in the ability to walk (P<0.05). A rehabilitation program was proposed focusing on modifiable factors that affect disability level. CONCLUSION: It was possible to describe the profile of disability in this group of patients, identifying the requirements to the community ambulation.

Disability profile of patients with HTLV-I-associated myelopathy/tropical spastic paraparesis using the Functional Independence Measure (FIM).

STUDY DESIGN: Survey. OBJECTIVE: To determine the disability profile of a group of patients with human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), using the Functional Independence Measure (FIM) to identify the most affected functional areas. SETTING: Reference center for HTLV Rio de Janeiro, Brazil. METHODS: A total of 72 patients (49 female and 23 male), consecutively referred by tertiary care centers, were assessed using the FIM. RESULTS: The average FIM score was 108 (+/-12 SD) ranging from 58 to 122. The lowest items scores were obtained in locomotion and bladder management. When divided into two groups (above, and below or equal to the average score), there were significant differences (P<0.05) in age at time of assessment, in the degree of muscular power and in low back pain. There were no significant differences in terms of age of onset and duration of the disease. CONCLUSIONS: The most affected areas in FIM motor items were locomotion (walk and stairs) and bladder management. Age, strength in lower limbs and low back pain interfere with functional activities in patients with HAM/TSP. The duration of the disease is not a significant factor for patient disabilities. The goals of rehabilitation in HAM/TSP patients should target the modifiable factors, such as pain, strength and the neurogenic bladder.

Isokinetic assessment of spasticity in subjects with traumatic spinal cord injury (ASIA A).

OBJECTIVE: To assess resistance to passive isokinetic movements at specified speeds and range of motion, as a measure of muscular tonus. METHODS: A group of 12 subjects with complete traumatic spinal cord injury and a group of 12 able-bodied subjects were analysed, distinguishing the level of spasticity in the SCI group. Maximum eccentric peak torque was observed in passive isokinetic flexion (F) and extension (E) knee movement in displacements of 30, 60 and 120 per second. RESULTS: The Student t-test showed that the average torque in the injured group was significantly higher than in the control group (F= 120 degrees per second, P<0.001). Variance analysis showed that the lower level presented lower torque levels (E=60 and 120 degrees per second, P<0.032), while those in the higher level presented higher torque levels (F and E=60 and 120 per second, P<0.032) when compared to the control group. In the control group the Student t-test (P<0.0006) showed a significantly different muscle behavior (Flexion>Extension Torque). CONCLUSION: By using isokinetic assessment it was possible to quantify hypertonic spasticity in a group of subjects with spinal cord injury, distinguishing groups with higher and lower levels of spasticity as compared to a control group.