title: Effect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy.
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.
authors.affiliation: Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Buell
authors.affiliation: Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
authors.forename: Aiysha
authors.initials: A
authors.lastname: Puri
authors.affiliation: Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Demontis
authors.affiliation: Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Short
authors.affiliation: National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
authors.forename: Adine
authors.initials: A
authors.lastname: Adonis
authors.affiliation: National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
authors.forename: Jana
authors.initials: J
authors.lastname: Haddow
authors.affiliation: Centre of Immunology and Infection, Hull York Medical School, Department of Biology, University of York, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Martin
authors.affiliation: National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
authors.forename: Divya
authors.initials: D
authors.lastname: Dhasmana
authors.affiliation: Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.|National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.|Centre of Immunology and Infection, Hull York Medical School, Department of Biology, University of York, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D016207:Cytokines / Q000378:metabolism; D005260:Female; D015368:Human T-lymphotropic virus 1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000150:complications* / Q000188:drug therapy*; D015493:Paraparesis, Tropical Spastic / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D012189:Retrospective Studies; D014554:Urination / Q000187:drug effects; D019562:Viral Load / Q000187:drug effects; D016138:Walking
chemical_list: D016207:Cytokines; D008775:Methylprednisolone