Neurological Signs and Symptoms in Patients with HTLV-1 Myelopathy

Myelopathy due to Human T Lymphocyte virus Type 1or Human associated myelopathy (Tropical Spastic paraparesis) is one of the clinical manifestations of this virus which is endemic in specific areas including the North-Eastern part of Iran. The aim of this case- control study was to evaluate the neurological symptoms and signs among patients who had already been identified as affected by the virus.The patients’ family background and medical history in terms of HTlV1 infection were evaluated. In addition, through administrating a laboratory investigation, sensory examination was used to detect any pain, vibration and/or priprioception in both upper and lower extremities. The evaluation of motor system was done according to force (0 to 5 on the basis of Medical Research Council Power Classification) and tonicity (based on the Modified Asworth Scale). Deep tendon reflexes as well as sphincter complaints were also investigated.Among 15 cases (3 males, 12 females), the average age was 50.6±16.5 years. The average duration of symptomatic was found to be 5.6±4.1 years. Two patients reported to have background history of Htlv1 infection. The most common complaints by the patients were: paresthesia (53.3%), muscular weakness (33.3%) and urination frequency (13.3%). None of the patients had atrophy. Symmetrical increase in tonicity was detected in both extremities; however, it was predominant in the lower ones (P=0.02).Urinary complaints may be the first clinical presentation of HAM/TSP. The most common sensory sign in our patients was paresthesia. We suggest that all the patients with problems in symmetric sensory and/or motor system who are especially at risk of being exposed to HTLV1 infection as well as those who complain about urinary problems should be checked for HAM/TSP.