HTLV-I/II as a common etiology of myelopathies in Bahia, Brazil.

Infection by human T-cell lymphotrophic virus type I (HTLV-I) is associated with a myelopathy known as tropical spastic paraparesis (TSP). The prevalence of HTLV-I infection was found to be high in a pilot study in Bahia, Brazil. In the present study, among patients with myelopathy of unclear etiology, 27% (17/62) were immunoblot reactive to HTLV-I/II (serum and CSF), but none of 40 consecutive patients seen at the neurological clinic and having a well-established neurological diagnosis had detectable antibodies against those viruses (discrimination between HTLV-I and HTLV-II was not possible with the tests we used). The clinical syndrome of typical TSP with upper limb hyperreflexia was found to be a significant feature among the HTLV-I/II-seropositive patients compared to seronegative individuals. The 17 HTLV-I/II-reactive individuals had negative tests for syphilis, toxoplasmosis and schistosomiasis. TSP was also associated with female gender (P = 0.001). We conclude that TSP is strongly associated with HTLV-I/II infection in women in Bahia.

HTLV-I associated myelopathy: clinical and epidemiological profile.

The prevalence of HTLV-I reaches 1.8% among blood donors in Salvador, and 40% among chronic myelopathy patients in the state of Bahia, Brazil. The present study shows the epidemiological and clinical picture of patients attending the HAM/TSP Outpatient Unit at the Foundation of Neurology and Neorusurgery (FNN). 114 patients had epidemiologic data collected and 51 of these patients, who had regularly attended the HAM/TSP Unit for at least 1 year, were evaluated for signs, symptoms and disease progression. Most of the 114 patients were female (70%), of African descent, and with a mean age of 51. Sexually transmitted diseases and blood transfusion were the most common risk factors. Paraparesis with spasticity was the predominant sign (85%), bladder dysfunction occurred in 75%, intestinal dysfunction was recorded in 48%. Sensory examination was normal in 50% of the cases studied. The patients' functional status, as measured by the Kurtzke Disability Scale, during the 1 year observation period changed only in early disease. Steroid therapy with prednisone was the most commonly used treatment in this group.

[Transient ischemic attacks in a patient with superior vena cava obstruction: case report]. / Ataques isquêmicos transitórios em paciente com síndrome da veia cava superior. Relato de caso.

The superior vena cava obstruction is a relatively rare condition. We report the case of a 42 year old man suffering of hypertension for about fifteen years. He reported a cervical and thoracic pain for one year, that was related to a 95% of occlusion on the right coronary artery. An angioplasty has been done but the patient still related the thoracic pain. Afterwards the patient had recurrent episodes of right hemiplegia and hypertensive emergencies that have been treated with anti-hypertensive agents. A venous disease was suspected because of cyanosis in the face especially when episodes of transient ischemic attacks occurred. A venography showed obstruction of the right jugular vein near the junction with the superior vena cava. In conclusion, it was not possible to define with certainty the relationship between the two pathologies presented by the patient, even so, we call attention to the improvement of the neurological symptoms after the control of superior vena cava obstruction with the treatment.

[Prevalence of tardive dyskinesia among inpatients in psychiatric hospitals in Salvador, Bahia, Brazil]. / Prevalência de discinesia tardia em pacientes internados nos hospitais psiquiátricos de Salvador, Bahia, Brasil.

The authors present a cross-study on the occurrence of tardive dyskinesia (TD) among inpatients of psychiatric units of the city of Salvador during the month of September, 1992. After reviewing the literature, they comment the average prevalence found for TD: 1.65% in a population of 2,115 patients using a protocol based on the Simpson Scale.

[Buspirone chlorhydrate in the treatment of cerebellar ataxia]. / Clorhidrato de buspirona en el tratamiento de la ataxia cerebelosa.

AIM: To evaluate the efficiency of buspirone chlorhydrate in a group of patients who all presented sporadic or family primary cerebellar ataxia. PATIENTS AND METHODS: In this open label study of addiction, the following eligibility criteria were used: 1) Clinical: primary cerebellar ataxia; 2) Radiological: nuclear magnetic resonance showing pure cerebellar cortical atrophy; 3) Age: over 20 years old. Any patient with a history of food deficiency, alcoholism, neoplasic, infectious, degenerative and vascular diseases was excluded from taking part in the study. Of the 20 patients examined initially, 18 met the eligibility criteria, and of these 11 reached the end of the study, although drop outs were not related to treatment. Four patients had been diagnosed as suffering from cerebellar cortical atrophy of the sporadic type and the remaining seven had a family type cerebellar cortical atrophy. All the patients were thoroughly evaluated and received scores both at the beginning and at the end of the study, according to the modified Massaquoi scale for clinical evaluation of cerebellar functioning, and the Hamilton Anxiety Scale. They were all administered buspirone chlorhydrate in doses that progressively increased by 5 mg/month over a total period of 12 months. The maximum dose was considered to be 1 mg/kg body weight, without exceeding 60 mg. The increase in dosage was stopped if it was not well tolerated by the patient

HTLV-I-associated myelopathy/tropical spastic paraparesis in Brazil: a nationwide survey. HAM/TSP Brazilian Study Group.

To study the epidemiology of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Brazil, we conducted a nationwide survey between March 1994 and April 1995. Five centers from three regions of the country participated, enrolling 163 patients. Most patients came from the northeastern and southeastern regions (93.2%). Most enrollees were white women, 42.9% and 64.4%, respectively. The most common risk factors for infection included a history of venereal diseases (30.6%) and blood transfusion (21.6%). The median age at the beginning of the disease was 42 years. The main neurologic findings were spastic paraparesis, widespread brisk tendon jerks, bilateral Babinski's sign, and bladder dysfunction. Some interregional differences reached statistical significance. The ratio of females over males increased from south to north. In addition, in both southern and southeastern regions, whites prevailed, whereas in the northeast, mulattos predominated. This follows the normal distribution of the population in these regions. A significantly higher rate of venereal diseases was found in the southeast compared with the other regions studied. A history of intravenous drug use was more frequent among patients as the sample moves south. Finally, a fluctuating course of the disease was proportionally more frequent in the southern region.

Molecular epidemiology of human T-cell leukemia virus type I (HTLV-1) Brazil: the predominant HTLV-1s in South America differ from HTLV-ls of Japan and Africa, as well as those of Japanese immigrants and their relatives in Brazil.

To better understand the origin of human T-cell leukemia virus type l (HTLV-l) in South America, we conducted a phylogenetic study on 27 new HTLV-ls in Brazil. These were obtained from Brazilians of various ethnic origins, such as Japanese immigrants, whites, blacks and mulattos. We amplified and sequenced proviral DNAs of a part of the long terminal repeats. Phylogenetic trees revealed that all but 6 of the new isolates were not only similar to each other but also similar to HTLV-ls of other South American countries, including those from Amerindians. However, the isolates differed from the HTLV-ls of Africa and Japan. The other six isolates were from Japanese immigrants and were phylogenetically almost identical to HTLV-ls in Japan but different from the majority of South American HTLV-ls, including the other new Brazilian HTLV-ls. These findings indicate that the recent introduction of HTLV-1 from Japan is limited to Japanese immigrants. In addition, the results do not support the prevailing hypothesis that HTLV-ls in South America were introduced by blacks who were brought from Africa as slaves. Rather, these results suggest that the majority of HTLV-1s prevailing in South America have spread from Amerindians, some of whom are likely to have possessed this human retrovirus from the beginning of their settlement in South America.

Prevalência de discinesia tardia em pacientes internados nos hospitais psiquiátricos de Salvador, Bahia, Brasil / Prevalence of tardive dyskinesia on hospitalized patients in psychiatric hospitals from Salvador, Bahia, Brazil

Os autores apresentam estudo transversal da prevalência da discinesia tardia (DT) em pacientes internados em unidades psiquiátricas da cidade de Salvador durante o mês de setembro-1992. Após revisäo da literatura, comentam a prevalência média de DT encontrada: 1,65 por cento na populaçäo de 2115 pacientes, usando protocolo baseado na escala de Simpson

HTLV-I/II as a common etiology of myelopathies in Bahia, Brazil

Infection by human T-cell lymphotrophic virus type I (HTLV-I) is associated with a myelopathy known as tropical spastic paraparesis (TSP). The prevalence of HTLV-I infection was found to be high in a pilot study in Bahia, Brazil. In the present study, among patients with myleopathy of unclear etiology, 27 per cent (17/62) were immunoblot reactive to HTLV-I/II (serum and CSF), but none of 40 consecutive patients seen at the neurological clinic and having a well-established neurological diagnosis had detectable antibodies against those viruses (discrimination between HTLV-I and HTLV-II was not possible with the tests we used). The clinical syndrome of typical TSP with upper limb hyperreflexia was found to be a significant feature among the HTLV-I/II-seropositive patients compared to seronegative individuals. The 17 HTLV-I/II-reactive individuals had negative tests for syphilis, toxoplasmosis and schistosomiasis. TSP was also associated with female gender (P=0.001). We conclude that TSP is strongly associated with HTLV-I/II infection in women in Bahia.

Clorhidrato de buspirona en el tratamiento de la ataxia cerebelosa / Buspirone chlorhydrate in the treatment of cerebellar ataxia

Objetivo. Evaluar la eficacia del clorhidrato de buspirona en un grupo de pacientes que se caracteriza por presentar una ataxia cerebelar primaria de tipo esporádico o familiar. Pacientes y métodos. Se trata de un estudio prospectivo de adición (open label study).Se utilizaron los siguientes criterios de inclusión: 1) Clínico: ataxia cerebelar primaria; 2) Radiológico: resonancia magnética que mostró una atrofia cortical cerebelar pura; 3) Edad: por encima de los 20 años. Se excluyeron del estudio todos los pacientes con historial de deficiencia alimentaria, alcoholismo, enfermedades neoplásicas, infecciosas, degenerativas y vasculares. De los 20 pacientes examinados inicialmente, 18 cumplieron los criterios de inclusión. De éstos, tan sólo 11 llegaron hasta el final del estudio, sin que los abandonos estuvieran relacionados con el tratamiento. Cuatro pacientes tenían un diagnóstico de atrofia cortical cerebelar de tipo esporádica, y siete, de atrofia cortical cerebelar de tipo familiar. Todos los pacientes se evaluaron de manera minuciosa y recibieron puntuaciones tanto al inicio como al final del estudio, según la escala de Massaquoi modificada para la evaluación clínica de la función cerebelar y según la escala de Hamilton para la ansiedad. A todos los pacientes se les administró clorhidrato de buspirona, con un aumento progresivo de la dosis de 5 mg/mes, durante un total de 12 meses. La dosis máxima considerada fue de 1 mg/kg de peso, sin sobrepasar los 60 mg. La progresión de la dosis se interrumpió cuando el paciente no la toleró (AU)