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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.51 no.3 São Paulo Sept. 1993

http://dx.doi.org/10.1590/S0004-282X1993000300005 

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)

 

 

Abelardo Q-C AraújoI; Cristiane R. AfonsoII; Ana Claudia B. LeiteI; Solange V. DultraI

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).

 

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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.

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