HTLV-1 seronegative idiopathic progressive spastic paraparesis: Clinical and neurophysiological study of the sensory features

Background: HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/ TSP) is a defined entity. However there are many patients nor well characte rized with a similar clinical picture who are HTLV-I seronegative. Objectiv e: Clinical and neurophysiological description of patients with HTLV-1 sero negative idiopathic paraparesia, Patients and Methods: Seventeen patients ( 4 women and 13 men aged 24-67 years, average 52.3) were evaluated including clinical assessment, vibratory sensory analysis, quantitative somatosensor y thermotest (QST), somatosensory evoked potentials (SSEPs), electromyograp hy (EMG) and motor and sensory nerve conductions. Results: lit addition to The spastic paraparesis, 3 (17.6%)patients had pseudobulbar symptoms. Tell (58.8%) patients bad a spastic gait but could walk unaided, 6 (35.2%) neede d support and 1 patient could;lot walk. Bladder dysfunction was found in 10 (58.8) patients and sensory symptoms in 7 (41.1%). There was mild distal i mpairment of vibration and position sense, distal tactile and pinprick hypo esthesia in 4 (23.4%) patients. Tibial SSEPs were abnormal in 11 (64.7%). N erve conduction studies and EMG were normal. QST showed cold hypoesthesia i n 14 (82.4%) patients, Warm sensation and beat pain appeared unimpaired. Co nclusions: All sensory abnormalities found were restricted to sensations ca rried by myelinated (A beta and A delta) channels. Sensory and motor abnorm alities are similar to HAM/TSP patients suggesting a common pathogenesis (R ev MM Chile 2001; 129: 731-41).