Intravenous methylprednisolone in HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP)

Q-C Araújo, Abelardo; Afonso, Cristiane R.; Leite, Ana Claudia B.; Dultra, Solange V.

doi:10.1590/S0004-282X1993000300005

Abstracts

HTLV-I (Human T-lymphotropic virus type I) associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immunomediated myelopathy induced by the HTLV-I. Some patients, specially those from Japan, seem to have a good response to steroid treatment. However, this has not been found in other regions of the world. High dose intravenous methylprednisolone has been used with success in patients with relapses of multiple sclerosis (MS), another autoimmune disease of the central nervous system. To test the effectiveness of methylprednisolone in patients with HAM/TSP, we devised an open trial in 23 patients. We found a very limited benefit of this form of treatment in these patients. Only one patient, who had the shortest disease duration (five months) in the whole group, showed a sustained benefit. We speculate that those patients with a shorter history, with presumably less demye-lination and more inflammatory lesions, would show a better response to immunossupressive treatments.

HTLV-I; tropical spastic paraparesis; methylprednisolone

A mielopatia associada ao protovírus T-linfotrópico humano (HTLV-I), também conhecida como paraparesia espástica tropical associada ao HTLV-I (MAH/PET), constitui enfermidade imunomediada desencadeada pela infecção pelo HTLV-I. Nesta condição tem sido demonstrada, particularmente em pacientes japoneses, boa resposta clínica à terapêutica com corticosteróides. Este efeito benéfico todavia não foi encontrado em todas as regiões do mundo. Pulsoterapia com metilprednisolona endovenosa tem sido utilizada com sucesso em pacientes com esclerose múltipla, outro exemplo de doença auto-imune do sistema nervoso central, especialmente durante as fases de exacerbação da doença. Objetivando testar a eficácia da pulsoterapia com metilprednisolona em pacientes com MAH/PET, conduzimos estudo aberto em 23 doentes. Não constatamos efeito benéfico significativo desta forma de tratamento na maioria dos enfermos estudados. Apenas um dos pacientes, o qual exibia o menor tempo de duração de doença (cinco meses), obteve benefício a longo prazo. Acreditamos que tratamentos imunossupressivos devam ser de maior utilidade naqueles doentes com menor tempo de evolução, nos quais, possivelmente, há preponderância do processo inflamatório sobre o desmielinizante.

HTLV-I; paraparesia espástica tropical; metilprednisolona

Abelardo Q-C Araújo^I; Cristiane R. Afonso^II; Ana Claudia B. Leite^I; Solange V. Dultra^I

^IHTLV Associated Neuropathies Unit, Evandro Chagas Hospital, FIOCRUZ, Rio de Janeiro

^IIInstituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro

SUMMARY

HTLV-I (Human T-lymphotropic virus type I) associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immunomediated myelopathy induced by the HTLV-I. Some patients, specially those from Japan, seem to have a good response to steroid treatment. However, this has not been found in other regions of the world. High dose intravenous methylprednisolone has been used with success in patients with relapses of multiple sclerosis (MS), another autoimmune disease of the central nervous system. To test the effectiveness of methylprednisolone in patients with HAM/TSP, we devised an open trial in 23 patients. We found a very limited benefit of this form of treatment in these patients. Only one patient, who had the shortest disease duration (five months) in the whole group, showed a sustained benefit. We speculate that those patients with a shorter history, with presumably less demye-lination and more inflammatory lesions, would show a better response to immunossupressive treatments.

Key words: HTLV-I, tropical spastic paraparesis, methylprednisolone.

RESUMO

A mielopatia associada ao protovírus T-linfotrópico humano (HTLV-I), também conhecida como paraparesia espástica tropical associada ao HTLV-I (MAH/PET), constitui enfermidade imunomediada desencadeada pela infecção pelo HTLV-I. Nesta condição tem sido demonstrada, particularmente em pacientes japoneses, boa resposta clínica à terapêutica com corticosteróides. Este efeito benéfico todavia não foi encontrado em todas as regiões do mundo. Pulsoterapia com metilprednisolona endovenosa tem sido utilizada com sucesso em pacientes com esclerose múltipla, outro exemplo de doença auto-imune do sistema nervoso central, especialmente durante as fases de exacerbação da doença. Objetivando testar a eficácia da pulsoterapia com metilprednisolona em pacientes com MAH/PET, conduzimos estudo aberto em 23 doentes. Não constatamos efeito benéfico significativo desta forma de tratamento na maioria dos enfermos estudados. Apenas um dos pacientes, o qual exibia o menor tempo de duração de doença (cinco meses), obteve benefício a longo prazo. Acreditamos que tratamentos imunossupressivos devam ser de maior utilidade naqueles doentes com menor tempo de evolução, nos quais, possivelmente, há preponderância do processo inflamatório sobre o desmielinizante.

Palavras-chave: HTLV-I, paraparesia espástica tropical, metilprednisolona.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Acknowledgements We thank Drs. Maria José de Andrada-Serpa and Doris Schor for their excellent technical assistance. This work was supported, in part, by a grant (E-11/150.763/91) from the Rio de Janeiro State Research Foundation (FAPERJ).

Aceite: 9-dezembro-1902.

Dr. Abelardo de Queiroz-Campos Araújo Unidade de Neuropatias Associadas ao HTLV, Hospital Evandro Chagas, FIOCRUZ - Av. Brasil 4365 - 21040-361 Rio de Janeiro RJ - Brasil. Fax 5521-5809988.

1. Araújo AQ-C. Do protovírus T-linfotrópico humano e de suas manifestações neurológicas. Thesis. Niterói: Universidade Federal Fluminense, 1991.
2. Araújo AQ-C, Freitas MRG, Nascimento O. Da patogenia das neuropatias associadas ao protovíruos T-linfotrópico humano (HTL.V-I). Rev Bras Neurol 1992, 57-63.
3. Araújo AQ-C, Ali A, Newell A, Dalgleish AG, Rudge P. HTL.V-I infection and neurological disease in Rio de Janeiro. J Neurol Neurosurg Psychiatry 1992, 55:153-155.
4. Bhagavati S, Ehrlich G, Kula RW, Kwok S, Sninky J, Udani V, Poiesz BJ. Detection of human T-cell lymphoma/leukemia virus type I DNA and antigen in spinal fluid and blood of patients with chronic progressive myelopathy. N Engl J Med 1988, 318:1141-1147.
5. Compston A. Methylprednisolone and multiple sclerosis. Arch Neurol 1988, 45:669-670.
6. Duncan J, Rudge P. Methylprednisolone therapy in tropical spastic paraparesis. J Neurol Neurosurg Psychiatry 1990, 53:173-174.
7. Gout O, Gessain A, Bolgert F, Saal F, Tournier-Lasserve E, Lasneret J, Caudie C, Bru-net P, De-Thé G, Lhermitte F, Lyon-Caen O. Chronic myelopathies associated with human T-lymphotropic virus type I. Arch Neurol 1989, 46:255-260.
8. Itoyama Y, Minato S, Kira J-I, Goto I, Okochi K, Yamamoto N. Immunological aspects of HTLV-1 -associated myelopathy (HAM). In: Román GC, Vernant J-C, Osame M. HTLV-I and the nervous system. New York: Alan R. Liss, 1989, p 287-295.
9. Iwasaki Y. Pathology of chronic myelopathy associated with HTLV-I infection (HAM/ TSP). J Neurol Sci 1990, 96:103-123.
10. Kurtzke JF. Further notes on disability evaluation in multiple sclerosis, with scale modifications. Neurology 1965, 15:654-661.
11. Osame M. Review of WHO Kagoshima meeting and diagnostic guidelines for HAM/TSP. In: Blattner W, ed. Human Retrovirology: HTLV. New York: Raven Press, 1990, p 191-197.
12. Osame M, Igata A, Matsumoto M. HTLV-I-associated myelopathy (HAM) revisited. In: Román GC, Vernant J-C, Osame M. HTLV-I and the Nervous System. New York: Alan R. Liss, 1989, p 213-223.
13. Osame M, Janssen R, Kubota H, Nishitani H, Igata A, Nagataki S, Mori M, Goto I. Shimabukuro H, Khabbaz R, Kaplan J. Nationwide survey of HTLV-I-associated myelopathy in Japan: association with blood transfusion. Ann Neurol 1990, 28:50-56.
14. Osame M, Matsumoto M, Usuku K, Izumo S, Ijichi N, Amitani H, Tara M, Igata A. Chronic progressive myelopathy associated with elevated antibodies to human T-lymphotropic virus type I and adult T-cell leukemia-like cells. Ann Neurol 1987, 21:117-122.
15. Osame M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A, Matsumoto M, Tara M. HTLV-I associated myelopathy, a new clinical entity. Lancet 1986, 1:1031-1032.
16. Rodgers-Johnson P, Morgan OStC, Mora C, Sarin P, Ceroni M, Piccardo P, Garruto RM, Gibbs CJ, Gajdusek DC. The role of HTLV-I in tropical spastic paraparesis in Jamaica. Ann Neurol 1988, 23(Suppl):S121-S126.
17. Román GC, Osame M, Igata A. HTLV-1-associated myelopathy (HAM) and tropical spastic paraparesis (TSP). In: Román GC, Vernant J-C, Osame M, eds. HTLV-I and the Nervous System. New York: Alan R. Liss, 1989, p 93-98.
18. Vernant JC, Maurs L, Gessain A, Barin F, Gout O, Delaporte JM, Sanhadji K, Buisson G, De Thé G. Endemic tropical spastic paraparesis associated with human T-lymphotropic virus type I: a clinical and seroepidemiological study of 25 cases. Ann Neurol 1987, 21:123-130.
19. Yoshida M, Miyoshi I, Hinuma Y. Isolation and characterization of retrovirus from cell lines of human adult T-cell leukemia and its implication in the disease. Proc Natl Acad Sci USA 1982, 79:2031-2035.
20. Zaninovic V, Arango C, Rodgers-Johnson P, Concha M, Corral R, Barreto P, Borrero I, Garruto RM, Gibbs CJ, Gajdusek DC. Tropical spastic paraparesis in Colombia. Ann Neurol 1988, 23(Suppl):S127-S132.

Intravenous methylprednisolone in HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP)

Metilprednisolona endovenosa na mielopatia associada ao HTLV-I/Paraparesia Espástica Tropical (MAH/PET)

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Sept 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Araújo AQ-C. Do protovírus T-linfotrópico humano e de suas manifestações neurológicas. Thesis. Niterói: Universidade Federal Fluminense, 1991.

[2] 2. Araújo AQ-C, Freitas MRG, Nascimento O. Da patogenia das neuropatias associadas ao protovíruos T-linfotrópico humano (HTL.V-I). Rev Bras Neurol 1992, 57-63.

[3] 3. Araújo AQ-C, Ali A, Newell A, Dalgleish AG, Rudge P. HTL.V-I infection and neurological disease in Rio de Janeiro. J Neurol Neurosurg Psychiatry 1992, 55:153-155.

[4] 4. Bhagavati S, Ehrlich G, Kula RW, Kwok S, Sninky J, Udani V, Poiesz BJ. Detection of human T-cell lymphoma/leukemia virus type I DNA and antigen in spinal fluid and blood of patients with chronic progressive myelopathy. N Engl J Med 1988, 318:1141-1147.

[5] 5. Compston A. Methylprednisolone and multiple sclerosis. Arch Neurol 1988, 45:669-670.

[6] 6. Duncan J, Rudge P. Methylprednisolone therapy in tropical spastic paraparesis. J Neurol Neurosurg Psychiatry 1990, 53:173-174.

[7] 7. Gout O, Gessain A, Bolgert F, Saal F, Tournier-Lasserve E, Lasneret J, Caudie C, Bru-net P, De-Thé G, Lhermitte F, Lyon-Caen O. Chronic myelopathies associated with human T-lymphotropic virus type I. Arch Neurol 1989, 46:255-260.

[8] 8. Itoyama Y, Minato S, Kira J-I, Goto I, Okochi K, Yamamoto N. Immunological aspects of HTLV-1 -associated myelopathy (HAM). In: Román GC, Vernant J-C, Osame M. HTLV-I and the nervous system. New York: Alan R. Liss, 1989, p 287-295.

[9] 9. Iwasaki Y. Pathology of chronic myelopathy associated with HTLV-I infection (HAM/ TSP). J Neurol Sci 1990, 96:103-123.

[10] 10. Kurtzke JF. Further notes on disability evaluation in multiple sclerosis, with scale modifications. Neurology 1965, 15:654-661.

[11] 11. Osame M. Review of WHO Kagoshima meeting and diagnostic guidelines for HAM/TSP. In: Blattner W, ed. Human Retrovirology: HTLV. New York: Raven Press, 1990, p 191-197.

[12] 12. Osame M, Igata A, Matsumoto M. HTLV-I-associated myelopathy (HAM) revisited. In: Román GC, Vernant J-C, Osame M. HTLV-I and the Nervous System. New York: Alan R. Liss, 1989, p 213-223.

[13] 13. Osame M, Janssen R, Kubota H, Nishitani H, Igata A, Nagataki S, Mori M, Goto I. Shimabukuro H, Khabbaz R, Kaplan J. Nationwide survey of HTLV-I-associated myelopathy in Japan: association with blood transfusion. Ann Neurol 1990, 28:50-56.

[14] 14. Osame M, Matsumoto M, Usuku K, Izumo S, Ijichi N, Amitani H, Tara M, Igata A. Chronic progressive myelopathy associated with elevated antibodies to human T-lymphotropic virus type I and adult T-cell leukemia-like cells. Ann Neurol 1987, 21:117-122.

[15] 15. Osame M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A, Matsumoto M, Tara M. HTLV-I associated myelopathy, a new clinical entity. Lancet 1986, 1:1031-1032.

[16] 16. Rodgers-Johnson P, Morgan OStC, Mora C, Sarin P, Ceroni M, Piccardo P, Garruto RM, Gibbs CJ, Gajdusek DC. The role of HTLV-I in tropical spastic paraparesis in Jamaica. Ann Neurol 1988, 23(Suppl):S121-S126.

[17] 17. Román GC, Osame M, Igata A. HTLV-1-associated myelopathy (HAM) and tropical spastic paraparesis (TSP). In: Román GC, Vernant J-C, Osame M, eds. HTLV-I and the Nervous System. New York: Alan R. Liss, 1989, p 93-98.

[18] 18. Vernant JC, Maurs L, Gessain A, Barin F, Gout O, Delaporte JM, Sanhadji K, Buisson G, De Thé G. Endemic tropical spastic paraparesis associated with human T-lymphotropic virus type I: a clinical and seroepidemiological study of 25 cases. Ann Neurol 1987, 21:123-130.

[19] 19. Yoshida M, Miyoshi I, Hinuma Y. Isolation and characterization of retrovirus from cell lines of human adult T-cell leukemia and its implication in the disease. Proc Natl Acad Sci USA 1982, 79:2031-2035.

[20] 20. Zaninovic V, Arango C, Rodgers-Johnson P, Concha M, Corral R, Barreto P, Borrero I, Garruto RM, Gibbs CJ, Gajdusek DC. Tropical spastic paraparesis in Colombia. Ann Neurol 1988, 23(Suppl):S127-S132.