Abstract
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immune mediated myelopathy caused by the human T-lymphotropic virus type 1 (HTLV-1). The efficacy of treatments used for patients with HAM/TSP is uncertain. The aim of this study is to document the efficacy of pulsed methylprednisolone in patients with HAM/TSP. Data from an open cohort of 26 patients with HAM/TSP was retrospectively analysed. 1g IV methylprednisolone was infused on three consecutive days. The outcomes were pain, gait, urinary frequency and nocturia, a range of inflammatory markers and HTLV-1 proviral load. Treatment was well tolerated in all but one patient. Significant improvements in pain were: observed immediately, unrelated to duration of disease and maintained for three months. Improvement in gait was only seen on Day 3 of treatment. Baseline cytokine concentrations did not correlate to baseline pain or gait impairment but a decrease in tumour necrosis factor-alpha (TNF-α) concentration after pulsed methylprednisolone was associated with improvements in both. Until compared with placebo, treatment with pulsed methylprednisolone should be offered to patients with HAM/TSP for the treatment of pain present despite regular analgesia.
Highlights
The human T lymphotropic virus type 1 (HTLV-1) was recognised as the first human retrovirus, with oncogenic potential, following its discovery by independent groups in the USA[1] and Japan[2]
Of the 25 patients treated with 1g IV Methylprednisolone on three consecutive days, 24 completed the treatment without any side effects
The prevalence of the improvement in pain gradually decreased over time
Summary
The human T lymphotropic virus type 1 (HTLV-1) was recognised as the first human retrovirus, with oncogenic potential, following its discovery by independent groups in the USA[1] and Japan[2]. The prevalence of HTLV-1, estimated at 5–10 million worldwide, is variable between and even within countries[3]. High prevalence, defined as greater than 1:10,000 of the general population or greater than 1:100 first time blood donors, is reported in Japan, the Caribbean, Western and Southern Africa, South America and Melanesia[4]. European countries have a low prevalence with the exception of Romania[4]. Gessain et al first reported the PLOS ONE | DOI:10.1371/journal.pone.0152557. Gessain et al first reported the PLOS ONE | DOI:10.1371/journal.pone.0152557 April 14, 2016
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