FURTHER-STUDIES ON HTLV-I-ASSOCIATED MYELOPATHY IN ARGENTINA

We report 10 HTLV-I virus seropositive subjects, eight of them with HT LV-I associated myelopathy (HAM), two of them also infected with HIV a s well as two asymptomatic HTLV-I+ relatives of two unrelated patients . HTLV-I is endemic in several tropical areas, where it causes differe nt neurological diseases. Only few patients have been reported in our country since 1994. We studied 8 patients, who fulfilled the clinical criteria for chronic spastic paraplegia, and 2 other non-symptomatic H TLV-I seropositive relatives, with electromyography (EMG), motor and s ensory conduction velocities (NCV), somatosensory, visual and brainste m auditory evoked potentials (SSEP, VEP and BAEP), Magnetic Resonance Images (MRI) and cerobrospinal fluid (CSF) analysis. The latter was ca rried out only in seven symptomatic patients. in every case positive E LISA tests for HTLV-I/II were confirmed by Western Blot. The two asymp tomatic persons were clinically and electromyographically assessed, on e of them was also submitted to SSEPs studies. Three patients were mat es. Patient's ages ranged from 5 to 65 years old. All symptomatic pati ents showed muscular weakness, spasticity with pyramidal signs and sph incter disturbances. Five of them had paresthesias and 2 had burning p ain on their feet. The EMGs and the NCVs were normal in 7 patients and in the 2 asymptomatic ones. SSEPs, obtained by stimulating the poster ior tibial nerves, were impaired in 7 patients and in the asymptomatic person who received the procedure. The 7 symptomatic patients who und erwent lumbar puncture had positive tests for HTLV-I in CSF, 3 out of these 7 patients had also high protein levels and 4 had increased numb er of lymphocytes. In 2 patients intrathecal IgG production could also be demonstrated. MRI were normal in 7 patients and in the 2 asymptoma tics, the exception being a female who had bilateral hyperintense lesi ons in cerebral white matter in T2. In conclusion, tropical spastic pa raparesis is apparently a rare disorder in Argentina. However, some ca ses have been reported recently. Most probably, its prevalence is curr ently underestimated. Its diagnosis should be considered in every pati ent with progressive spastic paraplegia.