Tropical spastic paraparesis: Difference between revisions

Jump to navigation Jump to search
Aditya Govindavarjhulla (talk | contribs)
No edit summary
WikiBot (talk | contribs)
m Changes made per Mahshid's request
 
(10 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Infobox_Disease |
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 29487 |
  ICD10          = {{ICD10|G|04|1|g|00}} |
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 1038 |
  MeshID        = D015493 |
}}
 
{{Tropical_spastic_paraparesis}}
{{Tropical_spastic_paraparesis}}
{{CMG}}
{{CMG}}


{{SK}} Tropical spastic paraplegia;
{{SK}} Tropical spastic paraplegia
==Overview==
 
'''Tropical spastic paraparesis''' ('''TSP''') is an [[infection]] of the [[spinal cord]] by [[Human T-lymphotropic virus]] resulting in [[paraparesis]] or weakness of the legs.  As the name suggests, it is most common in [[tropical]] regions, including the [[Caribbean]] and [[Africa]].
 
==History==
For several decades the term tropical spastic paraparesis was used to describe a chronic and progressive clinical syndrome that affected adults living in equatorial areas of the world. This condition was initially thought to be associated with infectious agents (such as [[Treponema pertenue]] and [[Treponema pallidum]] which cause inflammation of the [[central nervous system]]) and with chronic nutritional deficiencies (such as [[avitaminosis]]) or exposure to potentially toxic foods (such as bitter [[cassava]]). Neurological and modern neuroepidemiological studies found that in some individuals no single cause could explain the progressive weakness, sensory disturbance, and sphincter dysfunction that affected individuals with TSP. In spite of public health programs created to eradicate the above-mentioned infectious and nutritional conditions in the tropics, large numbers of people continued to be affected.


During the mid-1980s, an important association was established between the first human retrovirus-human T-cell lymphotrophic virus type 1 (also known as [[HTLV-1]])-and idiopathic TSP (idiopathic means of unknown origin). Since then, this condition has been named HTLV-1 associated myelopathy/ tropical spastic paraparesis or HAM/TSP and scientists now understand that it is a condition caused by a [[virus]] that results in immune dysfunction.
==[[Tropical spastic paraparesis overview|Overview]]==


==Presentation==
==[[Tropical spastic paraparesis historical perspective|Historical Perspective]]==
Patients with HAM/TSP may also exhibit [[uveitis]] (inflammation of the uveal tract of the eye), [[arthritis]] (inflammation of one or more joints), [[alveolitis|pulmonary lymphocytic alveolitis]] (inflammation of the lung tissues), [[polymyositis]] (an inflammatory muscle disease), [[keratoconjunctivitis sicca]] (persistent dryness of the cornea and conjunctiva), and [[dermatitis|infectious dermatitis]] (inflammation of the skin). Co-factors that may play a role in transmitting the disorder include being a recipient of transfusion blood products (especially before 1989), [[breast feeding|breastmilk feeding]] from a [[seropositive]] mother, [[intravenous drug]] use, or being the sexual partner of a seropositive individual for several years. Not every HTLV-1 seropositive carrier will become a HAM/TSP patient. Fewer than 5% will exhibit neurological dysfunction or, eventually, hematological malignancy such as [[adult T-cell leukemia]]/lymphoma, suggesting that other host or viral factors are responsible for disease onset.
==[[Tropical spastic paraparesis classification|Classification]]==
 
==[[Tropical spastic paraparesis pathophysiology|Pathophysiology]]==
==Pathogenesis==
==[[Tropical spastic paraparesis causes|Causes]]==
When infected by [[HTLV-1]] the host mounts an antigen specific immune response towards the [[HTLV-1]] antigen. [[Cytotoxic T-lymphocytes]] of the host’s immune response release [[cytokines]] in an effort to fight the infection. These [[cytokines]] facilitate the [[endothelium|transendothelial]] migration of [[lymphocytes]] across the blood-brain barrier. Once [[cytokines]] are within the central nervous system demyelination is brought as a result of bystander cell injury.  The disease is [[chronic (medicine)|chronic]], progressing slowly, usually causing symptoms 20-30 years after infection.
==[[Tropical spastic paraparesis differential diagnosis|Differentiating Tropical spastic paraparesis from other Diseases]]==
 
==[[Tropical spastic paraparesis epidemiology and demographics|Epidemiology and Demographics]]==
==Symptoms==
==[[Tropical spastic paraparesis risk factors|Risk Factors]]==
* Progressive muscle weakness;
==[[Tropical spastic paraparesis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* Sensory disturbance
==Diagnosis==
* [[Sphincter]] dysfunction
[[Tropical spastic paraparesis history and symptoms|History and Symptoms]] | [[Tropical spastic paraparesis physical examination|Physical Examination]] | [[Tropical spastic paraparesis laboratory findings|Laboratory Findings]] | [[Tropical spastic paraparesis other diagnostic studies|Other Diagnostic Studies]]
* [[Urinary]] incontinence
* [[Uveitis]]
* [[arthritis]]
* Pulmonary lymphocyte alveolitis
* [[Polymyositis]]
* [[Keratoconjunctivitis]] sicca
* Infectious [[dermatitis]]
 
==Prevention==
Blood transfusion products are screened for [[HTLV-1]] antibodies.


==Treatment==
==Treatment==
There is no established treatment program for HAM/TSP although some patients may be given [[steroids]]. Clinical studies using [[interferon|interferon alpha]] and [[plasmapheresis]] have not shown significant patient improvement. [[Spasticity]] may be treated with [[lioresal]] or [[tizanidine]]. Urinary dysfunction should be treated with self-catheterization or [[oxybutynin]].
[[Tropical spastic paraparesis medical therapy|Medical Therapy]] | [[Tropical spastic paraparesis primary prevention|Primary Prevention]] | [[Tropical spastic paraparesis secondary prevention|Secondary Prevention]] | [[Tropical spastic paraparesis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Tropical spastic paraparesis future or investigational therapies|Future or Investigational Therapies]]


==Prognosis==
==Case Studies==
HAM/TSP is usually a progressive neurological disorder but it is rarely fatal. Most patients live for several decades after the diagnosis. Their prognosis improves if they take steps to prevent urinary tract infection and skin sore formation, and if they enroll in physical and occupational therapy programs.
[[Tropical spastic paraparesis case study one|Case #1]]


==References==
* {{cite journal |author=Machigashira N, Yoshida Y, Wang S, Osame M |title=HTLV-1-associated myelopathy/tropical spastic paraparesis with pseudohypoparathyroidism |journal=Neurology |volume=56 |issue=1 |pages=104-6 |year=2001 |pmid=11148245 |url=http://www.neurology.org/cgi/content/full/56/1/104}}


{{Diseases of the nervous system}}
{{Diseases of the nervous system}}
Line 62: Line 30:


[[Category:Viral diseases]]
[[Category:Viral diseases]]
[[Category:Infectious disease]]
 
[[Category:Neurology]]
[[Category:Neurology]]



Latest revision as of 19:01, 18 September 2017

For patient information click here

Tropical spastic paraparesis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tropical spastic paraparesis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Tropical spastic paraparesis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Tropical spastic paraparesis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Tropical spastic paraparesis

CDC on Tropical spastic paraparesis

Tropical spastic paraparesis in the news

Blogs on Tropical spastic paraparesis

Directions to Hospitals Treating Tropical spastic paraparesis

Risk calculators and risk factors for Tropical spastic paraparesis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Tropical spastic paraplegia

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tropical spastic paraparesis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


Template:Diseases of the nervous system Template:Viral diseases

Template:WH Template:WS