INFORMATION ON TROPICAL SPASTIC PARAPARESIS

Tropical spastic paraparesis is an infection of the spinal cord by Human T-lymphotropic virus resulting in paraparesis or weakness of the legs. As the name suggests, it is most common in tropical regions, including the Caribbean and Africa.

Tropical spastic paraparesis is used to describe a chronic and progressive clinical syndrome that affected adults living in equatorial areas of the world. This condition was initially thought to be associated with infectious agents and with chronic nutritional deficiencies or exposure to potentially toxic foods. Neurological and modern neuroepidemiological studies found that in some individuals no single cause could explain the progressive weakness, sensory disturbance, and sphincter dysfunction that affected individuals with Tropical spastic paraparesis. In spite of public health programs created to eradicate the above-mentioned infectious and nutritional conditions in the tropics, large numbers of people continued to be affected

SYNONYMS OF TROPICAL SPASTIC PARAPARESIS

1. Retrovirus-Associated Myelopathy
2. HTLV-1 Associated Myelopathy
3. Jamaican neuropathy
4. Tropical myeloneuropathy
5. Human T lymphotropic virus1 (HTLV-1) associated Myelopathy (TSP/HAM)

CAUSES OF TROPICAL SPASTIC PARAPARESIS

Tropical spastic paraparesis is caused by the HTLV-1 virus, which also causes leukemia. The virus can be spread through the placenta, and also through blood transfusions, breastfeeding, contaminated needles, and sexual contact.

SYMPTOMS OF TROPICAL SPASTIC PARAPARESIS

Symptoms may begin years after infection. In response to the infection, the body's immune response may injure nerve tissue, causing symptoms that include bladder abnormalities, leg pain, and loss of feeling in the feet, tingling sensations, and unpleasant sensations when the skin is touched.

Others are:-

1. Progressive muscle weakness;
2. Sensory disturbance
3. Sphincter dysfunction
4. Urinary incontinence
5. Uveitis
6. Arthritis
7. Pulmonary lymphocyte alveolitis
8. Polymyositis
9. Keratoconjunctivitis sicca
10. Infectious dermatitis

DIAGNOSIS OF TROPICAL SPASTIC PARAPARESIS

Diagnosis of Tropical spastic paraparesis criteria typically involves:-

1. Absence of a history of difficulty walking or running during school age back pain; 2 Symmetric weaknesses of the lower extremities within six months of onset: complaints of numbness or dysesthesias of the legs or feet

2. A clinical examination documenting increased reflexes; spasticity of legs, abnormal gait, and absence of normal sensory level


3. Laboratory diagnoses using enzyme-linked immunosorbent assay detects the presence of antibodies against HTLV-1, confirmed by the western blot assay.

4. Electro diagnostic studies and magnetic resonance imaging may also be helpful to show evidence of active denervation, associated with HTLV-1.

TREATMENT OF TROPICAL SPASTIC PARAPARESIS

There is no established treatment program for Tropical Spastic Paraparesis although some patients may be given steroids. Spasticity may be treated with lioresal or tizanidine. Urinary dysfunction should be treated with self-catheterization or oxybutynin. A current trial with interferon beta 1a is underway.

While the disease is incurable, significant improvement has been reported in the condition of Tropical Spastic Paraparesis patients treated with corticosteroids. These drugs are believed to alleviate symptoms by suppressing the immune system's response to the virus that causes them.

Plasmapheresis, a dialysis-like procedure in which symptom-producing antibodies are removed from the blood, also provides temporary relief.