Intrathecal synthesis of antibodies to human T lymphotropic virus type I and the presence of IgG oligoclonal bands in the cerebrospinal fluid of patients with endemic tropical spastic paraparesis

Tropical spastic paraparesis (TSP), a neuromyelopathy predominantly involving the pyramidal tract and commonly observed in tropical and equatorial areas, was recently found to be associated with human T lymphotropic virus type I (HTLV-I). We investigated sera and cerebrospinal fluid (CSF) from 19 patients with TSP who were from the Caribbean area, French Guiana, and Africa. Our results showed an elevated intra-blood-brain barrier IgG synthesis rate and an elevated IgG index, with an increased HTLV-I antibody-to-albumin ratio and the presence of CSF oligoclonal bands in the majority of the patients. These data, in association with similar HTLV-I antibody patterns between patients with TSP who were from these three regions, strenghten the probable etiologic role of HTLV-I in the pathogenesis of such chronic neuromyelopathies. (AU)

Jamaican neuropathy: an electrophysiological study

Jamaican neuropathy (JN) is a common disorder in Jamaica and has characteristics similar to neurological diseases found in other tropical areas. JN is a clinical syndrome and occurs in two forms: spastic and ataxic. This is the first known electrophysiological study of this disease. In the spastic group of JN, peripheral electrophysiological findings were mostly normal, suggesting a central cause for their symptoms. The only patient with the ataxic form of JN had a chronic axonal peripheral neuropathy. (AU)

HTLV-I-like viral particles in spinal cord cells in Jamaican tropical spastic paraparesis

Viral-like particles morphologically identical to human T-lymphotropic virus type I or II, but distinct from human T-lymphotropic virus type III, have been seen by electron microscopy in spinal cord tissue from a Jamaican tropical spastic paraparesis patient who was known to be positive for human T-lymphotropic virus I antibody before death. This is the first electron microscopy report on a patient from an endemic tropical spastic paraparesis region. (AU)

Pathological and immunological observations on tropical spastic paraparesis in patients from Jamaica

The neuropathological examination of the spinal cord of 2 Jamaican patients with classical tropical spastic paraparesis disclosed an intense chronic meningomyelitis with demyelination. In the 1 case in which serum and cerebrospnal fluid were available, antibodies to the human T-lymphotropic virus type 1 were found. (AU)

The role of HTLV-I in tropical spastic paraparesis in Jamaica

We report clinical and laboratory investigations of 47 native-born Jamaican patients with endemic tropical spastic paraparesis and of 1 patient with tropical ataxic neuropathy. Mean age at onset was 40 years, with a female-male preponderance (2.7:1). Neurological features of endemic tropical spastic paraparesis are predominantly those of a spastic paraparesis with variable degrees of proprioceptive and/or superficial sensory impairment. Using enzyme-linked immunoabsorbent assay (ELISA), IgG antibodies to human T-lymphotropic virus type I (HTLV-I) were present in 82 percent of sera and 77 percent of cerebrospinal fluids. On Westren blot analysis, IgG antibodies detected the p19 and p24 gag-encoded core proteins in both serum and cerebrospinal fluid. Titers were tenfold higher by ELISA in serum than in cerebrospinal fluid, and some oligoclonal bands present in fluid were not seen in serum . Serum-cerebrospinal fluid albumin ratios wer normal, and IgG indexes indicated intrathecal IgG synthesis. Histopathological changes showed a chronic inflammatry reaction with mononuclear cell infiltration, perivascular cuffing, and demyelination that was predominant in the lateral colmns. In 1 patient, a retrovirus morphologically similar to HTLV-I on electron microscopy was isolated from spinal fluid. Our investgations show that endemic tropical spastic paraparesis in Jamaica is a retrovirus-assiciated myelopathy and that HTLV-I or an antigenically similar retrovirus is the causal agent. (AU)

The neuroepidemiology of tropical spastic paraparesis

Recent neuroepidemiological studies of endemic tropical spastic paraparesis (TSP) have confirmed the existence of high-prevalence foci in several tropical islands, including Jamaica and Martinique in the Caribbean, Tumaco off the Pacific coast of Colombia, and the Seychelles in the Indian Ocean. There is a net preponderance of TSP in persons of Black African ancestry, although Caucasian, Hindu, Amerindian, and Orientals have been affected. The epidemiological, clinical, laboratory, and neuropathological features of TSP are reviewed here, as well as the evidence in favor of its retroviral origin. (AU)

Plasma thiocyanate and free radicals in Jamaican neuropathy (tropical paraparesis

Tropical spastic paraparesis (TSP) in West African countries is caused by a combination of excess cyanide from the ingestion of cassava and a deficiency of the sulphur-containing amino-acids required to detoxify the cyanide. Free radical damage to long axons has also been reported to result in damage similar to that seen in Jamaican TSP. To investigate the possibility that these mechanisms may be responsible for Jamaican TSP, venous blood from non-smoking blood donors and 22 patients with TSP were analysed for thiocyanate, superoxide dismutase and glutathione. Serum thiocyanate is an index of cyanide exposure. Superoxide damage is an important sulphur-containing peptiae. Levels of thiocyanate in the patients with TSP were similar to those in control patients. Glutathione was elevated in all the patients, and a superoxide dismutase activity was normal. The low levels of thiocyanate suggest that cyanide toxicity is not the primary cause of Jamaican TSP and, in any event, sufficient amounts of sulphur-containing amino-acids are present to detoxify cyanide. Free radical mechanisms are also unlikely to be responsible for damage to the neurons in these patients (AU)

Antibody to human T-lymphotropic virus type 1 in West-Indian-born UK residents with spastic paraparesis

Of 13 West-Indian-born UK residents with spastic paraparesis of unknown cause, 11 were tested for serum antibody to human T-cell lymphotropic virus type 1 and all were positive. Their magnetic resonance imaging scans were normal or showed only minor abnormalities in the brain, and the spinal cord was normal in the 5 investigated. Of 48 patients with multiple sclerosis, mainly caucasian, none had antibody to HTLV-1 in the blood.(AU)

Hyperreflexia and spastic paralysis among New Caledonian leprosy patients

A survey on New Caledonia confirmed the occurrence of a previously reported syndrome of spastic paralysis among leprosy patients. Of 18 patients recorded as having frank spastic paraplegia, seven were examined neurologically, as well as 51 other patients with leprosy but not spastic paralysis, and 23 patients with tuberculosis. Significant hyperreflexia was fairly common among both Melanesian and European leprosy patients, but was totally absent among tuberculosis patients. This syndrome was clinically unrelated to foci of neurologic disease previously reported in the Pacific Basin on Guam, the Kii Peninsula of Japan, and New Guinea. It is probably more closely related to diseases reported in other parts of the world that are generally regarded as nutritional or toxic in origin. The syndrome is possibly related to sulfone treatment of leprosy, although this has not been reported in other areas of the world where sulfones are used in the treatment of leprosy.(AU)