Median Nerve Somatosensory Evoked Potential in HTLV-I Associated Myelopathy
Keywords:
HTLV-I, HAM/TSP, SSEPs, Spinal CordAbstract
Introduction: HTLV-I Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a progressive Myelopathy that mainly involves the corticospinal tract. Despite pronounced involvement of the lower limbs, patients also have abnormalities in their upper limbs. So, we studied somatosensory-evoked potentials (SSEPs) of the median nerve in HAM/TSP patients to determine the extent of the involvement of the pathway of the central nervous system, especially the cervical spinal cord.
Methods: In this cross sectional study, 48 patients with HAM/TSP who were referred to Qaem Hospital in Mashhad from October 2010 to October 2011 were evaluated for various indices, including SSEPs of the median nerve for N9, N11, N13, and N20 waveforms and also N11-13 and N13-20 Inter Peak Latency (IPL), severity of disease (based on Osama criteria), disease duration (less or more than 2 years), age, and gender. SPSS software was used for data analysis. The t-test was used for quantitative data, and the chi-squared test was used for the qualitative variables.
Results: Thirty-four patients (70.2%) were females. The mean age was 45.6 ± 14.2 years. About SSEPs indices of the median nerve, N9 and N11 were normal in all patients, but N13 (50%), N20 (16.7%), IPL11-13 (58.3%), and IPL13-20 (22.9%) were abnormal. No significant relationships were found between age, gender, disease duration, and SSEPs indices (p > 0.05), but IPL11-13 and IPL13-20 had significant relationships with disease disability (p = 0.017 and p = 0.01, respectively).
Conclusion: Despite the lack of obvious complaints of upper limbs, SSEPs indices of the median nerve from the cervical spinal cord to the cortex were abnormal, which indicated extension of the lesion from the thoracic spinal cord up to the cervical spinal cord and thalamocortical pathways. Also, abnormalities in the cervical spinal cord had a direct correlation with the severity of disability in patients with HAM/TSP.
References
Poiesz BJ, Ruscetti FW, Gazdar AF, Bunn PA, Minna JD, Gallo RC. Detection and isolation of type C
retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma. Proc
Natl Acad Sci U S A. 1980; 77(12): 7415-9. doi: 10.1073/pnas.77.12.7415, PMID: 6261256, PMCID:
PMC350514.
Gessain A, Barin F, Vernant JC, Gout O, Maurs L, Calender A, et al. Antibodies to human T-lymphotropic
virus type-I in patients with tropical spastic paraparesis. Lancet. 1985; 2(8452): 407-10. doi:
1016/S0140-6736(85)92734-5, PMID: 2863442.
LaGrenade L, Hanchard B, Fletcher V, Cranston B, Blattner W. Infective dermatitis of Jamaican children: a
marker for HTLV-I infection. Lancet. 1990; 336(8727): 1345-7. doi: 10.1016/0140-6736(90)92896-P,
PMID: 1978165.
Inose M, Higuchi I, Yoshimine K, Suehara M, Izumo S, Arimura K, et al. Pathological changes in skeletal
muscle in HTLV-I-associated myelopathy. J Neurol Sci. 1992; 110(1-2): 73-8. doi: 10.1016/0022- 510X(92)90012-A, PMID: 1506872.
Sowa JM, Human T. lymphotropic virus I, myelopathy, polymyositis and synovitis: an expanding
rheumatic spectrum. J Rheumatol. 1992; 19(2): 316-8. PMID: 1629837.
Kawai H, Inui T, Kashiwagi S, Tsuchihashi T, Masuda K, Kondo A, et al. HTLV-I infection in patients
with autoimmune thyroiditis (Hashimoto's thyroiditis). J Med Virol. 1992; 38(2): 138-41. doi:
1002/jmv.1890380212, PMID: 1460458.
Kimura I. [HABA (HTLV-I associated bronchiolo-alveolar disorder)].Nihon KyobuShikkan Gakkai Zasshi.
; 30(5): 787-95. PMID: 1630042.
Miyoshi I, Miyamoto K, Sumida M, Nishihara R, Lai M, Yoshimoto S, et al. Chromosome 14q+ in adult T- cell leukemia. Cancer Genet Cytogenet. 1981; 3(3): 251-9. doi: 10.1016/0165-4608(81)90092-3, PMID:
Abbaszadegan MR, Gholamian M, Tabatabaee A, Farid R, Houshmand M, Abbaszadegan M. Prevalence of
human T-lymphotropic virus type 1 among blood donors from mashhad, Iran. J Clin Microbiol. 2003; 41:
-5. doi: 10.1128/jcm.41.6.2593-2595.2003, PMID: 12791885, PMCID: PMC156501.
Osama M, Matsumoto M, Usuku K, Izumo S, Ijichi N, Amitani H, et al. Chronic progressive myelopathy
associated with elevated antibodies to human T-lymphotropic virus type I and adult T-cell leukemialike
cells. Ann Neurol. 1987; 21(2): 117-22. doi: 10.1002/ana.410210203, PMID: 2881513.
Osama M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A, et al. HTLV-I associated myelopathy, a new
clinical entity. lancet. 1986; 1(8488): 1031-2. PMID: 2871307.
Gessain A, Caudie C, Gout O, Vernant JC, Maurs L, Giordano C, et al. 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. J Infect Dis. 1988; 157(6): 1226-34. doi:
1093/infdis/157.6.1226, PMID: 2897399.
Iannone R, Sherman MP, Rodgers-Johnson PE, Beilke MA, Mora CA, Amin RM, et al. HTLV-I DNA
sequences in CNS tissue of a patient with tropical spastic paraparesis and HTLV-I-associated myelopathy. J
Acquir Immune Defic Syndr. 1992; 5(8): 810-6. doi: 10.1097/00126334-199208000-00007, PMID:
Iwasaki Y. Pathology of chronic myelopathy associated with HTLV-I infection (HAM/TSP). J Neurol Sci.
; 96(1): 103-23. doi: 10.1016/0022-510X(90)90060-Z, PMID: 2351985.
Arimura K, Rosales R, Osama M, Igata A. Clinical electrophysiologic studies of HTLV-I-associated
myelopathy. Arch Neurol. 1987; 44(6): 609-12. doi: 10.1001/archneur.1987.00520180033012, PMID:
Ugawa Y, Kohara N, Shimpo T, Mannen T. Central motor and sensory conduction in
adrenoleukomyeloneuropathy, cerebrotendinous xanthomatosis, HTLV-1-associated myelopathy and
tabesdorsalis. J Neurol Neurosurg Psychiatry. 1988; 51(8): 1069-74. doi: 10.1136/jnnp.51.8.1069, PMID:
, PMCID: PMC1033116.
Moritoyo H, Arimura K, Arimura Y, Tokimura Y, Rosales R, Osama M. Study of lower limb
somatosensory evoked potentials in 96 cases of HTLV-I-associated myelopathy/tropical spastic
paraparesis. J Neurol Sci. 1996; 138(1-2): 78-81. doi: 10.1016/0022-510X(95)00351-2, PMID: 8791242.
Young RE, Morgan OS, Forster A. Motor pathway analysis in HAM/TSP using magnetic stimulation and
F-waves. Can J Neurol Sci. 1998; 25(1): 48-54. doi: 10.1017/S0317167100033485, PMID: 9532281.
Suga R, Tobimatsu S, Kira J, Kato M. Motor and somatosensory evoked potential findings in HTLV-I
associated myelopathy. J Neurol Sci. 1999; 167(2): 102-6. doi: 10.1016/S0022-510X(99)00148-3.
Boostani R, Mellat Ardekani A, Ashrafi H. Khorasan Disease: Prevalence of HTLV-I Associated
Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) In West Azarbaijan from 2004 to 2007. Iran Red
Crescent Med J. 2011; 13(6): 428-30. PMID: 22737507, PMCID: PMC3371933.
Nakagawa M, Izumo S, Ijichi S, Kubota H, Arimura K, Kawabata M, et al. HTLV-I-associated
myelopathy: analysis of 213 patients based on clinical features and laboratory findings. J Neurovirol. 1995;
(1): 50-61. doi: 10.3109/13550289509111010, PMID: 9222342.
Orland JR, Engstrom J, Fridey J, Sacher RA, Smith JW, Nass C, et al. Prevalence and clinical features of
HTLV neurologic disease in the HTLV Outcomes Study. Neurology. 2003; 61(11): 1588-94. doi:
1212/01.WNL.0000096011.92542.DA, PMID: 14663047.
Quintas S, Moreno T, Lobo-Antunes N, Levy-Gomes A. [Tropical spastic paraparesis and HTLV-I
associated myelopathy in infancy. A case report and review of the literature]. Rev Neurol. 2004; 39(12):
-6. PMID: 15625631.
Shimizu H, Shiga Y, Fujihara K, Ohnuma A, Itoyama Y. Clinical and physiological significance of
abnormally prolonged central motor conduction time in HAM/TSP. J Neurol Sci. 2001; 185(1): 39-42. doi:
1016/S0022-510X(01)00455-5, PMID: 11266689.
Kakigi R, Kuroda Y, Takashima H, Endo C, Neshige R, Shibasaki H. Physiological functions of the
ascending spinal tracts in HTLV-I-associated myelopathy (HAM). Electroencephalogr Clin Neurophysiol.
; 84(2): 110-4. doi: 10.1016/0168-5597(92)90015-4, PMID: 1372225.
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