title: HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP): A comparative study to identify factors that influence disease progression.
abstract: OBJECTIVE
  HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) can progress slowly or rapidly even though a set of symptoms such as spastic paraparesis with pathological reflexes and sweating loss of the lower extremities are commonly observed in patients. Although most of the patients are thought to be infected to HTLV-1 from their mothers by breast feeding, symptoms of HAM/TSP typically manifest in patients later in life (50-60years old in age) and also with a higher prevalence of women to men at a ratio of approximately 3:1. Probability of developing HAM/TSP and how fast an individual's disease may progress from the time of diagnosis could be multifactorial.
  
  
  METHODS
  We reviewed the records of 150 patients with HAM/TSP admitted to Kagoshima University Hospital between 2002 and 2014. Laboratory data of cerebrospinal fluid and serum and the clinical measurements including age, age of disease onset, progression rate, duration of illness, initial symptoms, Osame's Motor Disability Score were evaluated. Rapid disease progression of the disease was defined by deterioration of motor disability by >3 grades within 2years.
  
  
  RESULTS
  Of 150 HAM/TSP patients in our cohort, 114 cases (76%) were females. Patients presenting with rapid disease progression are approximately 15years older at the age of onset than those with a protracted disease course, and have increased number of cell, and elevated levels of protein as well as anti-HTLV-1 antibody titer in the CSF, suggesting a more active inflammatory process. There is no significant difference in the average values of clinical and laboratory parameters between the sexes. Furthermore, there is no apparent correlation between rate of disease progression and gender.
  
  
  CONCLUSIONS
  Our results suggest that age and virus mediated inflammation are correlated with disease phenotypes while additional factors such as host or HTLV-1 genetics and gender may influence disease susceptibility.
authors.affiliation: Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan. Electronic address: pine@m.kufm.kagoshima-u.ac.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Matsuura
authors.affiliation: Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozuma
authors.affiliation: Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tashiro
authors.affiliation: Department of Molecular Pathology, Center for Chronic Viral Diseases, Kagoshima University, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kubota
authors.affiliation: Department of Molecular Pathology, Center for Chronic Viral Diseases, Kagoshima University, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Izumo
authors.affiliation: Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takashima
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D002648:Child; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015493:Paraparesis, Tropical Spastic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D010641:Phenotype; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Disease course; Gender; HAM/TSP; Rapid progression