title: Corticosteroid therapy in TSP/HAM patients: the results from a 10 years open cohort.
abstract: BACKGROUND
  The use of corticosteroids for treating tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) has yielded controversial results. We report the use of corticosteroids for the treatment of TSP/HAM in an open cohort.
  
  
  METHODS
  The clinical efficacy of long-term, high dose of corticosteroid therapy was studied in thirty-nine TSP/HAM patients. Disability and motor dysfunction was evaluated based on the Disability Status Scale (DSS), Osame's Motor Disability Scales (OMDS), and Incapacity Status Scale (ISS), before and after treatment. Treatment included use of methyl-prednisolone, 1 g/day for three days, every 3-4 months. The primary end-point was a change in the scores of the neurological scales from baseline until the fifth visit after therapy.
  
  
  RESULTS
  After a mean follow-up of 2.2 years and an average of four pulses per patient, we noted a significant neurological improvement, reaching 24.5% according to the ISS score. No statistically significant differences in scores according to the OMDS and DSS scales were noted.
  
  
  CONCLUSIONS
  We observed neurological improvement with the use of corticosteroids, with physical therapy and antispastic-drugs as adjunctive treatment. However, randomized clinical trials should be done to assess the use of corticosteroids and other potentially useful immune-based therapies for TSP/HAM treatment.
authors.affiliation: HTLV Clinic, Institute of Infectious Diseases Emílio Ribas, São Paulo, Brazil.
authors.forename: Mariana Garcia
authors.initials: MG
authors.lastname: Croda
authors.forename: Augusto César Penalva
authors.initials: AC
authors.lastname: de Oliveira
authors.forename: Maria Paulina Posada
authors.initials: MP
authors.lastname: Vergara
authors.forename: Francisco
authors.initials: F
authors.lastname: Bonasser
authors.forename: Jerusa
authors.initials: J
authors.lastname: Smid
authors.forename: Alberto José da Silva
authors.initials: AJ
authors.lastname: Duarte
authors.forename: Jorge
authors.initials: J
authors.lastname: Casseb
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D015493:Paraparesis, Tropical Spastic / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones