[Vestibular evoked myogenic potential findings on multiple sclerosis]. / Hallazgos de potenciales vestibulares miogénicos evocados en la esclerosis múltiple.

INTRODUCTION: Vestibular evoked myogenic potential (VEMP) elicited by acoustic stimulation, has been proposed in the assessment of vestibulospinal pathways. AIM: To research the clinical utility of VEMP on multiple sclerosis (MS). SUBJECTS AND METHODS: Forty-four individuals were evaluated (30 normal state and 14 had MS). The acoustic stimuli were short tone burst (1 kHz, 118 dBNa, rise-fall 1 ms, plateau 2 ms) presented through a supra-aural earphone. The stimulation rate was 5 stimuli per second. RESULTS: All the healthy subjects showed a normal VEMP response. In the MS group, abnormal VEMP was recorded among 92.8% of patients and normal in just one case. The P13-N23 increased of prolongation which was the most frequently alteration (57.1%), followed by absence of response among four (28.5%) cases. CONCLUSION: VEMP was considered a good method of diagnostic support of vestibulospinal tract in cases of MS.

HLA class I alleles in HTLV-1-associated myelopathy and asymptomatic carriers from the Brazilian cohort GIPH.

INTRODUCTION AND OBJECTIVES: The development of HTLV-1-associated myelopathy (HAM/TSP) in HTLV-1-infected individuals is probably a multi-factor event, in which the immune system plays a crucial role. The efficiency of the host immunity seems to be one of the in vivo determining factors of the proviral load levels and is regulated by genes associated with MHC class I alleles (HLA). Protection or predisposition to HTLV-1-associated diseases according to individual HLA profile was shown in Japanese studies. The present work tested for HLA alleles previously related to protection or susceptibility to HTLV-1-associated myelopathy in a cohort study (GIPH) from Brazil. METHODS: A total of 93 HTLV-1-infected individuals participated in the study, as follows: 84 (90.3%) asymptomatic and 9 (9.7%) with HAM/TSP. Alleles related to protection (A*02, Cw*08) and susceptibility (B*07, Cw*08 and B*5401) were tested by the PCR-SSP method. RESULTS: Allele A*02 was more frequent in the asymptomatic group and in its absence, Cw*07 was correlated with HAM/TSP (P = 0.002). Allele B*5401 was not present in the Brazilian population. Alleles B*07 and Cw*08 were not different between the groups DISCUSSION: The presence of HLA-A2 elicits a stronger cytotoxic response, which is involved in the HTLV-1 proviral load reduction. This study confirmed a tendency of this allele to protect against HAM-TSP. Therefore, A*02 might be of interest for researches involved with HTLV-1 vaccine.

HTLV-I associated infective dermatitis may be an indolent HTLV-I associated lymphoma.

When present for a first time blood donation, a 28-year-old Brazilian white female reported a pruritic eczema of the scalp and retroauricular areas since childhood that had been frequently infected. Her mother had been diagnosed as having HTLV-I-associated myelopathy (HAM), and the patient was found to be a human T-lymphotropic virus type-I (HTLV-I) carrier. The patient had been breast-fed for 6 months. The patient had a complete examination, and a biopsy was taken from eczema in the retroauricular area. The biopsy indicated chronic lymphohistiocytic dermatitis with no abnormal lymphocytes. Eleven months later, the patient had an infiltration in the skin of the retroauricular area and a new biopsy revealed atypical lymphocytes. Nested polymerase chain reaction (PCR) was positive for HTLV-I and immunohistochemistry of the tissue at this time confirmed adult T-cell leukemia/lymphoma (ATLL). Retrospective immunohistochemistry showed that the first fragment submitted from the biopsy 11 months before was also compatible with the diagnosis of ATLL. This case fulfilled all major criteria for diagnosis of HTLV-I-associated infective dermatitis (HTLV-I-ID). We postulate that the patient had indolent ATLL associated with HTLV-I infective dermatitis since childhood. We recommend that tissue immunohistochemistry analysis be done in any patient with HTLV-associated infective dermatitis.