A carrier of human T-lymphotropic virus type I with periodic limb movements progressing to myelopathy

Abstract

Human T-lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia and HTLV-I-associated myelopathy (HAM). HAM is characterized by slowly progressive paraplegia but often presents with involuntary movements. Periodic limb movements (PLMs), characterized by stereotyped, repetitive, nonepileptiform movements of the legs, with HAM are usually associated with motor paresis or occur after the development of myelopathy. We describe an HTLV-I carrier presenting with PLMs that progressed to myelopathy (HAM). A 34-year-old woman had a 4-year history of involuntary leg movements during sleep. Restless legs syndrome had been diagnosed at another hospital in August 2002. MRI of the brain, cervical spine, and lumbar spine showed no abnormalities. The EEG was normal. CSF showed 4 white blood cells (WBCs)/mm3 and a protein level of 44 mg/dL. The anti-HTLV-I antibody was positive in CSF (×8). The patient's mother was a healthy HTLV-I carrier. Because involuntary movements developed despite treatment with levodopa and clonazepam, the patient was admitted to our hospital in December 2002. The deep tendon …