Encephalomyelopathy associated with HTLV-I: A primary disease or coexisting with multiple sclerosis?

Champs, Ana Paula Silva; Passos, Valéria Maria de Azeredo; Barreto, Sandhi Maria; Caramelli, Paulo; Melo, Carla Meirelles de; Carvalho, Guilherme; Menezes, Miriam Melo; Ribas, João Gabriel Ramos

doi:10.1590/S1980-57642013DN74000014

ABSTRACT

HTLV-I-associated myelopathy (HAM/TSP) is the most common neurological manifestation of HTLV-I, causing progressive weakness, sensory disturbance, and sphincter dysfunction. Although motor disorders have been well described, few studies have associated cognitive disorders and HTLV-I infection. In areas endemic for HTLV-I infection, the differential diagnosis between HAM/TSP and other myelopathy etiologies can be difficult, particularly if the patient has signs and symptoms of brain involvement, since seropositive HTLV-I patients can present other neurological diseases. Here, we report one case initially diagnosed as Multiple Sclerosis (MS) which, upon further investigation, was found to be HTLV-I seropositive.

Key words:
HTLV -I; tropical spastic paraparesis; multiple sclerosis; cognition disorder; magnetic resonance imaging.

RESUMO

A mielopatia associada ao HTLV-I (HAM/TSP) é a manifestação neurológica mais frequente do HTLV-I causando fraqueza progressiva, alterações de sensibilidade e disfunção esfincteriana. As alterações motoras são bem descritas, mas ainda são poucos os estudos que examinam a possibilidade de ocorrência de transtornos cognitivos na infecção pelo HTLV-I. Em áreas endêmicas para o HTLV-I, o diagnóstico diferencial com outras causas de mielopatias pode ser difícil, particularmente se o paciente tem sinais e sintomas de acometimento encefálico, já que a sorologia positiva para o HTLV-I pode ser detectada em pacientes com outras doenças neurológicas. Aqui relata-se o caso de uma paciente inicalmente diagnosticada com Esclerose Múltipla e que, na investigação posterior, foi encontrado soropositividade para HTLV-I.

Palavras-chave:
HTLV -1; paraplegia tropical espástica; esclerose múltipla; distúrbio cognitivo; ressonância nuclear magnética.

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REFERENCES

¹
Ribas JG, Melo G C. Human T-cell lymphotropic virus type 1(HTLV-1)-associated myelopathy. Rev Soc Bras Med Trop 2002;35:377
²
Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292-302.
³
Ogata A, Nagashima K, Tashiro K, Miyakawa A, Mikuni C. MRI-pathological correlate of brain lesions in a necropsy case of HTLV-I associated myelopathy. J Neurol Neurosurg Psychiatry 1993;56:194-196.
⁴
Godoy AJ, Kira J, Hasuo K, Goto I. Characterization of cerebral white matter lesions of HTLV-I-associated myelopathy/tropical spastic paraparesis in comparison with multiple sclerosis and collagen-vasculitis: a semiquantitative MRI study. J Neurol Sci 1995;133:102-111.
⁵
Howard AK, Li DK, Oger J. MRI contributes to the differentiation between MS and HTLV-I associated myelopathy in British Columbian coastal natives. Can J Neurol Sci 2003;30:41-48.
⁶
Julian LJ. Cognitive Functioning in Multiple Sclerosis. Neurol Clin 2010; 29:507-525.
⁷
Porto CS, Fichman HC, Caramelli P, Bahia V S, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
⁸
Wechsler, D. Escala de Inteligência Wechsler para Adultos (WAIS): Manual técnico (3rd ed.). São Paulo: Casa do Psicólogo; 2004.
⁹
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. [Normative data on the verbal fluency test in the animal category in our milieu]. Arq Neuropsiquiatr 1997;55:56-61.
¹⁰
Machado TH, Fichman HC, Santos EL, et al. Normative data for healthy elderly on the phonemic verbal fluency task - FAS. Dement Neuropsychol 2009;3:55-60.
¹¹
Spreen O & Strauss E. A compendium of neuropsychological tests (2nd ed.). New York: Oxford University Press; 1998.
¹²
Diniz LFM, Cruz MF Torres VM Cosenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36: 79-83.
¹³
Critchley, M. The parietal lobes. London: Arnold; 1953.
¹⁴
Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18: 643-662.
¹⁵
Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC et al. Global epidemiology of HTLV-I infection and associated diseases. Oncogene 2005;24:6058-6068.
¹⁶
Kuroda Y, Matsui M, Yukitake M, et al.: Assessment of MRI criteria for MS in Japanese MS and HAM/TSP. Neurology 1995;45:30-33.
¹⁷
Puccioni-Sohler M, Yamano Y, Rios M, et al.: Differentiation of HAM/TSP from patients with multiple sclerosis infected with HTLV-I. Neurology 2007;68:206-213.
¹⁸
Silva MT, Mattos P, Alfano A, Araujo AQ. Neuropsychological assessment in HTLV-1 infection: a comparative study among TSP/HAM, asymptomatic carriers, and healthy controls. J Neurol Neurosurg Psychiatry 2003;74:1085-1089.
¹⁹
Puccioni-Sohler M, Rios M, Carvalho SM, et al. Diagnosis of HAM/TSP based on CSF proviral HTLV-I DNA and HTLV-I antibody index. Neurology 2001;57:725-727.

Publication Dates

Publication in this collection
Dec 2013

History

Received
30 Aug 2013
Accepted
04 Nov 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Ribas JG, Melo G C. Human T-cell lymphotropic virus type 1(HTLV-1)-associated myelopathy. Rev Soc Bras Med Trop 2002;35:377

[2] ²
Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292-302.

[3] ³
Ogata A, Nagashima K, Tashiro K, Miyakawa A, Mikuni C. MRI-pathological correlate of brain lesions in a necropsy case of HTLV-I associated myelopathy. J Neurol Neurosurg Psychiatry 1993;56:194-196.

[4] ⁴
Godoy AJ, Kira J, Hasuo K, Goto I. Characterization of cerebral white matter lesions of HTLV-I-associated myelopathy/tropical spastic paraparesis in comparison with multiple sclerosis and collagen-vasculitis: a semiquantitative MRI study. J Neurol Sci 1995;133:102-111.

[5] ⁵
Howard AK, Li DK, Oger J. MRI contributes to the differentiation between MS and HTLV-I associated myelopathy in British Columbian coastal natives. Can J Neurol Sci 2003;30:41-48.

[6] ⁶
Julian LJ. Cognitive Functioning in Multiple Sclerosis. Neurol Clin 2010; 29:507-525.

[7] ⁷
Porto CS, Fichman HC, Caramelli P, Bahia V S, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[8] ⁸
Wechsler, D. Escala de Inteligência Wechsler para Adultos (WAIS): Manual técnico (3rd ed.). São Paulo: Casa do Psicólogo; 2004.

[9] ⁹
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. [Normative data on the verbal fluency test in the animal category in our milieu]. Arq Neuropsiquiatr 1997;55:56-61.

[10] ¹⁰
Machado TH, Fichman HC, Santos EL, et al. Normative data for healthy elderly on the phonemic verbal fluency task - FAS. Dement Neuropsychol 2009;3:55-60.

[11] ¹¹
Spreen O & Strauss E. A compendium of neuropsychological tests (2nd ed.). New York: Oxford University Press; 1998.

[12] ¹²
Diniz LFM, Cruz MF Torres VM Cosenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36: 79-83.

[13] ¹³
Critchley, M. The parietal lobes. London: Arnold; 1953.

[14] ¹⁴
Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18: 643-662.

[15] ¹⁵
Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC et al. Global epidemiology of HTLV-I infection and associated diseases. Oncogene 2005;24:6058-6068.

[16] ¹⁶
Kuroda Y, Matsui M, Yukitake M, et al.: Assessment of MRI criteria for MS in Japanese MS and HAM/TSP. Neurology 1995;45:30-33.

[17] ¹⁷
Puccioni-Sohler M, Yamano Y, Rios M, et al.: Differentiation of HAM/TSP from patients with multiple sclerosis infected with HTLV-I. Neurology 2007;68:206-213.

[18] ¹⁸
Silva MT, Mattos P, Alfano A, Araujo AQ. Neuropsychological assessment in HTLV-1 infection: a comparative study among TSP/HAM, asymptomatic carriers, and healthy controls. J Neurol Neurosurg Psychiatry 2003;74:1085-1089.

[19] ¹⁹
Puccioni-Sohler M, Rios M, Carvalho SM, et al. Diagnosis of HAM/TSP based on CSF proviral HTLV-I DNA and HTLV-I antibody index. Neurology 2001;57:725-727.

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