Tropical spastic paraparesis. A clinical study of 50 patients from Tumaco (Colombia) and review of the worldwide features of the syndrome.
Tropical spastic paraparesis (TSP) is a chronic and slowly progressive endemic myelopathy occurring in geographical isolates in the Caribbean, South India, South Africa, the Seychelles, and Colombia. A detailed clinical and laboratory study was performed on 50 TSP patients from the island of Tumaco (Colombia), in a tropical rain forest area. Most patients were middle-aged blacks, 29 (58%) men and 21 women. In every case, neurological examination confirmed the presence of pyramidal signs in the lower limbs, plus, in 58%, moderate decrease in vibratory perception distally in the feet, bilaterally and symmetrically. Absent ankle jerks were found in 28%. Slow onset and chronic progression were documented in most patients. Positive treponemal serology, from yaws infection in childhood, was found in the serum in 92%, and in 19% also in the cerebrospinal fluid (CSF). No pleocytosis was documented on 27 CSF samples, but increased protein content occurred in 86%, with elevation of gamma-globulins in 78%. Treatment of 20 patients with high doses of penicillin produced no change in the clinical picture. TSP emerges from this review of the literature as a remarkably homogeneous clinical entity worldwide. A retrovirus-human T-lymphotropic virus type 1 (HTLV-1)--has been recently implicated as a possible etiology of the syndrome.
Román
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GC
Department of Neurology, Texas Tech University Health Sciences, Center School of Medicine, Lubbock 79430.
Román
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LN
D000328:Adult; D000368:Aged; D003105:Colombia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015493:Paraparesis, Tropical Spastic / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D013577:Syndrome