M. Nakagawa et al., HTLV-I-ASSOCIATED MYELOPATHY - ANALYSIS OF 213 PATIENTS BASED ON CLINICAL-FEATURES AND LABORATORY FINDINGS, Journal of neurovirology, 1(1), 1995, pp. 50-61
We studied the clinical features and laboratory findings in 213 patien
ts with HTLV-I-associated myelopathy/tropical spastic paraparesis as d
iagnosed in Kagoshima University Hospital. Some aspects of clinical fe
atures in HTLV-I-associated myelopathy/tropical spastic paraparesis we
re characterized by mode of HTLV-I transmission and age of onset. The
patients with onset after 15 years old and no history of blood transfu
sion before the onset of the disease (151 patients, group I) showed a
shorter interval between the time of disease onset and that of inabili
ty to walk. The patients with onset before 15 years old and without hi
story of blood transfusion (21 patients, group II) had short stature a
nd slow progression of the disease. The interval time and the progress
ion of the disease in patients with history of blood transfusion befor
e onset of disease (41 patients, group III) were in between those of t
he above two groups. Patients whose ages of onset were older than 61 y
ears old showed a faster progression than those with younger onset reg
ardless of the mode of HTLV-I transmission. HTLV-I-associated myelopat
hy/tropical spastic paraparesis patients often also showed other organ
disorders such as leukoencephalopathy (69%), abnormal findings on che
st X-ray (50%), Sjogren syndrome (25%) and arthropathy (17%). The pati
ents with low anti-HTLV-I antibody titers in the cerebrospinal fluid (
2X-8X by PA method) had an older age of onset on average, milder clini
cal symptoms and lesser increase of neopterin in the cerebrospinal flu
id than those in the high titer subgroup whose titers were higher than
1024X in cerebrospinal fluid regardless of the mode of HTLV-I transmi
ssion. We speculate that the clinical course of HTLV-I-associated myel
opathy/tropical spastic paraparesis mainly shows a slow progression wh
ich consists of an initial progressive phase (probably an inflammatory
phase) and a latter chronic phase, although some patients showed acut
e/subacute onset and rapid progression.