HTLV-1–associated myelopathy/tropical spastic paraparesis is a slowly progressive disorder of the spinal cord caused by the human T-lymphotropic virus 1 (HTLV-1).
The virus is spread through sexual contact, use of recreational injected drugs, exposure to blood, or breastfeeding.
People have weakness, stiffness, and muscle spasms in the legs, making walking difficult, and many have urinary incontinence.
To diagnose the disorder, doctors ask about possible exposure to the virus and do magnetic resonance imaging, a spinal tap, and blood tests.
Medications, such as corticosteroids, may help, and spasms are treated with muscle relaxants.
(See also Overview of Spinal Cord Disorders.)
The human T-lymphotropic virus 1 (HTLV-1) is similar to the human immunodeficiency virus (HIV), the virus that causes AIDS. The HTLV-1 virus can cause certain kinds of leukemia and lymphoma (cancers of the white blood cells).
HTLV-1 is transmitted through
Sexual contact
Use of recreational drugs that are injected into vein (intravenously) or skin
Exposure to blood
It can be transmitted from mother to child through breastfeeding. It is most common among sex workers, injection drug users, people undergoing hemodialysis, and people from certain areas such as those near the equator, southern Japan, and parts of South America.
HTLV-1–associated myelopathy/tropical spastic paraparesis is more common among women because HTLV-1 infection is more common among women.
A similar disorder can result from infection with a similar virus, human T-lymphotropic virus 2 (HTLV-2).
The virus resides in white blood cells. Because the cerebrospinal fluid contains white blood cells, the spinal cord can be damaged. Inflammation develops in the spinal cord and damages the pathways that carry signals about pain, temperature, and position up the spinal cord to the brain and those that carry signals from the brain down the spinal cord to muscles. Damage to the spinal cord results more from the body’s reaction to the virus than from the virus itself.
Symptoms of HAM/TSP
In people with HTLV-1–associated myelopathy/tropical spastic paraparesis, the muscles in both legs gradually become weak. People may not be able to feel vibrations in their feet and may lose the sense of where their feet and toes are (position sense). Their limbs feel stiff, movements become clumsy, and walking may become difficult. Muscle spasms in the legs are common, as is loss of bladder control (urinary incontinence) and urinary urgency (an urgent need to urinate).
HAM/TSP usually progresses over several years.
Diagnosis of HAM/TSP
Assessment of the person's risk of being exposed
Magnetic resonance imaging
Tests to check for the virus in blood and cerebrospinal fluid
The diagnosis of HTLV-1–associated myelopathy/tropical spastic paraparesis is usually based on symptoms and the person’s risk of being exposed to the virus. Thus, a doctor may ask people about their sexual contacts and use of recreational injected drugs.
Samples of blood and cerebrospinal fluid, obtained by a spinal tap (lumbar puncture), are tested for parts of the virus or antibodies to the virus. (Antibodies are produced by the immune system to defend against a particular attacker, such as HTLV-1.)
Magnetic resonance imaging (MRI) of the brain and spinal cord is done to check for abnormalities such as degeneration of the spinal cord and to check for other possible causes of the symptoms.
Treatment of HAM/TSP
Interferon alfa, immune globulin, and/or corticosteroids
For spasms, muscle relaxants
No treatment has been shown to be effective for HTLV-1–associated myelopathy/tropical spastic paraparesis. However, interferon alfa (an antiviral medication), intravenous immune globulin, and/or corticosteroids may slow the progression of the disorder and reduce disability and pain. (Intravenous immune globulin is a purified solution of antibodies obtained from volunteer donors and given by vein.)
