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Tropical Myeloneuropathies Treatment & Management

  • Author: Friedhelm Sandbrink, MD; Chief Editor: Niranjan N Singh, MD, DM  more...
Updated: Jan 13, 2015

Medical Care

The mainstay of treatment is symptomatic. No standard treatment is available for TAN or HAM/TSP.

  • HAM/TSP: A study of 131 patients reported that oral methylprednisolone produced excellent to moderate responses in 69.5% of patients.[10]
  • A 10-year, HAM/TSP, open-cohort trial using 1 g methylprednisolone every 3-4 months showed neurologic improvement with the use of corticosteroids.[11]
  • Symptomatic treatment is similar to that used in primary lateral sclerosis (please see article Primary Lateral Sclerosis for further details). Drugs that can be used include baclofen, tizanidine, and benzodiazepines. Physical therapy is used commonly in combination.
  • Patients with HAM/TSP or TAN sometimes report neuropathic pain. Useful drugs include antiepileptics (eg, carbamazepine, phenytoin, gabapentin, topiramate), baclofen, and tricyclic antidepressants. The dosages used usually are well bellow those used in the treatment of epilepsy. None of these drugs are approved by the FDA for this purpose.
  • Controlled trials of antiviral agents (eg, zidovudine) in HAM/TSP are under review.


Infectious disease specialist



TAN: Supplementation with multivitamins is recommended, but in most cases only minor improvement occurs. In areas where cassava flour is used, following standard cassava processing measures is imperative.

Contributor Information and Disclosures

Friedhelm Sandbrink, MD Assistant Professor of Neurology, Georgetown University School of Medicine; Assistant Clinical Professor of Neurology, George Washington University School of Medicine and Health Sciences; Director, EMG Laboratory and Chief, Chronic Pain Clinic, Department of Neurology, Washington Veterans Affairs Medical Center

Friedhelm Sandbrink, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Florian P Thomas, MD, PhD, Drmed, MA, MS Director, National MS Society Multiple Sclerosis Center; Professor and Director, Clinical Research Unit, Department of Neurology, Adjunct Professor of Physical Therapy, Associate Professor, Institute for Molecular Virology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, Drmed, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MD, DM Associate Professor of Neurology, University of Missouri-Columbia School of Medicine

Niranjan N Singh, MD, DM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

Carmel Armon, MD, MSc, MHS Chair, Department of Neurology, Assaf Harofeh Medical Center, Tel Aviv University Sackler Faculty of Medicine, Israel

Carmel Armon, MD, MSc, MHS is a member of the following medical societies: American Academy of Neurology, Massachusetts Medical Society, American Academy of Sleep Medicine, American Stroke Association, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American College of Physicians, American Epilepsy Society, American Medical Association, American Neurological Association, Sigma Xi

Disclosure: Received research grant from: Neuronix Ltd, Yoqnea'm, Israel.


Eliad Culcea, MD Consulting Staff, Department of Neurology, Benefis Medical Group

Eliad Culcea, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

  1. Izumo S, Umehara F, Osame M. HTLV-I-associated myelopathy. Neuropathology. 2000 Sep. 20 Suppl:S65-8. [Medline].

  2. Gilbert DT. Human T-cell leukaemia/lymphoma virus type-1 associated myeloneuropathies--a Caribbean perspective. West Indian Med J. 2012 Jul. 61(4):408-14. [Medline].

  3. Oluwole OS, Onabolu AO, Link H, Rosling H. Persistence of tropical ataxic neuropathy in a Nigerian community. J Neurol Neurosurg Psychiatry. 2000. 69(1):96-101. [Medline].

  4. Olindo S, Lezin A, Cabre P, et al. HTLV-1 proviral load in peripheral blood mononuclear cells quantified in 100 HAM/TSP patients: a marker of disease progression. J Neurol Sci. 2005 Oct 15. 237(1-2):53-9. [Medline].

  5. de Oliveira Mde F, Bittencourt AL, Brites C, et al. HTLV-I associated myelopathy/tropical spastic paraparesis in a 7-year-old boy associated with infective dermatitis. J Neurol Sci. 2004 Jul 15. 222(1-2):35-8. [Medline].

  6. Watanabe A, Kawajiri M, Ikezoe K, et al. HTLV-1-associated myelopathy/tropical spastic paraparesis accompanied with psoriasis. J Neurol Sci. 2004 Jun 15. 221(1-2):95-7. [Medline].

  7. Kiwaki T, Umehara F, Arimura Y, et al. The clinical and pathological features of peripheral neuropathy accompanied with HTLV-I associated myelopathy. J Neurol Sci. 2003 Jan 15. 206(1):17-21. [Medline].

  8. Bagnato F, Butman JA, Mora CA, et al. Conventional magnetic resonance imaging features in patients with tropical spastic paraparesis. J Neurovirol. 2005 Dec. 11(6):525-34. [Medline].

  9. Matsuzaki T, Nakagawa M, Nagai M, et al. HTLV-I proviral load correlates with progression of motor disability in HAM/TSP: analysis of 239 HAM/TSP patients including 64 patients followed up for 10 years. J Neurovirol. 2001 Jun. 7(3):228-34. [Medline].

  10. Nakagawa M, Nakahara K, Maruyama Y, et al. Therapeutic trials in 200 patients with HTLV-I-associated myelopathy/ tropical spastic paraparesis. J Neurovirol. 1996 Oct. 2(5):345-55. [Medline].

  11. Croda MG, de Oliveira AC, Vergara MP, Bonasser F, Smid J, Duarte AJ, et al. Corticosteroid therapy in TSP/HAM patients: the results from a 10 years open cohort. J Neurol Sci. 2008 Jun 15. 269(1-2):133-7. [Medline].

  12. Izumo S, Goto I, Itoyama Y, et al. Interferon-alpha is effective in HTLV-I-associated myelopathy: a multicenter, randomized, double-blind, controlled trial. Neurology. 1996 Apr. 46(4):1016-21. [Medline].

  13. Shirabe S, Nakamura T, Tsujino A, et al. Successful application of pentoxifylline in the treatment of HTLV-1 associated myelopathy. J Neurol Sci. 1997. 151(1):97-101. [Medline].

  14. Oh U, Yamano Y, Mora CA, et al. Interferon-beta1a therapy in human T-lymphotropic virus type I-associated neurologic disease. Ann Neurol. 2005 Apr. 57(4):526-34. [Medline].

  15. Araujo AQ, Andrade-Filho AS, Castro-Costa CM, et al. HTLV-I-associated myelopathy/tropical spastic paraparesis in Brazil: a nationwide survey. HAM/TSP Brazilian Study Group. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 15. 19(5):536-41. [Medline].

  16. Aye MM, Matsuoka E, Moritoyo T, et al. Histopathological analysis of four autopsy cases of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system. Acta Neuropathol (Berl). 2000 Sep. 100(3):245-52. [Medline].

  17. Bangham CR. HTLV-1 infections. J Clin Pathol. 2000 Aug. 53(8):581-6. [Medline].

  18. Castillo JL, Cea JG, Verdugo RJ, Cartier L. Sensory dysfunction in HTLV-I-associated myelopathy/tropical spastic paraparesis. A comprehensive neurophysiological study. Eur Neurol. 1999 Jul. 42(1):17-22. [Medline].

  19. Cavrois M, Gessain A, Gout O, et al. Common human T cell leukemia virus type 1 (HTLV-1) integration sites in cerebrospinal fluid and blood lymphocytes of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis indicate that HTLV-1 crosses the blood-brain barrier via clonal H. J Infect Dis. 2000 Oct. 182(4):1044-50. [Medline].

  20. Figueiroa FL, Andrade Filho AS, Crvalho ES. HTLV-I associated myelopathy: clinical and epidemiological profile. Braz J Infect Dis. 2000 Jun. 4(3):126-30. [Medline].

  21. Gazzola P, Cocito L, De Maria A, et al. Successful 2-year therapy with systemic interferon-alpha for HTLV-I associated myelopathy. J Neurol Sci. 1999 Jan 15. 162(2):205-7. [Medline].

  22. Giordano C, Dumas M, Hugon J, et al. [Tropical African neuromyelopathies: 61 studied cases in the Ivory Coast]. Rev Neurol (Paris). 1988. 144(10):578-85. [Medline].

  23. Guerreiro JB, Santos SB, Morgan DJ, et al. Levels of serum chemokines discriminate clinical myelopathy associated with human T lymphotropic virus type 1 (HTLV-1)/tropical spastic paraparesis (HAM/TSP) disease from HTLV-1 carrier state. Clin Exp Immunol. 2006 Aug. 145(2):296-301. [Medline].

  24. Hu CY, Lin MT, Yang YC, et al. Familial transmission of human T-lymphotropic virus type 1 (HTLV-1) in patients with adult T-cell leukemia/lymphoma or HTLV-1-associated myelopathy. J Formos Med Assoc. 1998 Feb. 97(2):101-5. [Medline].

  25. Leite AC, Mendonca GA, Serpa MJ, et al. Neurological manifestations in HTLV-I-infected blood donors. J Neurol Sci. 2003 Oct 15. 214(1-2):49-56. [Medline].

  26. Leite AC, Silva MT, Alamy AH, et al. Peripheral neuropathy in HTLV-I infected individuals without tropical spastic paraparesis/HTLV-I-associated myelopathy. J Neurol. 2004 Jul. 251(7):877-81. [Medline].

  27. Leon FE, Costa CM, Gaffga N. Discrepancy, coincidence or evidence in chronic idiopathic spastic paraparesis throughout the world. A meta-analysis on 2811 patients. Arq Neuropsiquiatr. 1997 Sep. 55(3B):530-5.

  28. Lezin A, Olindo S, Oliere S, et al. Human T lymphotropic virus type I (HTLV-I) proviral load in cerebrospinal fluid: a new criterion for the diagnosis of HTLV-I-associated myelopathy/tropical spastic paraparesis?. J Infect Dis. 2005 Jun 1. 191(11):1830-4. [Medline].

  29. Longe AC. Tropical myeloneuropathies: Clinical and electrophysiological findings in the Niger Delta area of Nigeria. East African Medical Journal. 1988. 65(9):614-620. [Medline].

  30. Manns A, Hisada M, La Grenade L. Human T-lymphotropic virus type I infection. Lancet. 1999 Jun 5. 353(9168):1951-8. [Medline].

  31. Matsuoka E, Takenouchi N, Hashimoto K, et al. Perivascular T cells are infected with HTLV-I in the spinal cord lesions with HTLV-I-associated myelopathy/tropical spastic paraparesis: double staining of immunohistochemistry and polymerase chain reaction in situ hybridization. Acta Neuropathol (Berl). 1998 Oct. 96(4):340-6. [Medline].

  32. Montanheiro PA, Montanheito PA, Oliveira AC, et al. Human T-cell lymphotropic virus type I (HTLV-I) proviral DNA viral load among asymptomatic patients and patients with HTLV-I-associated myelopathy/tropical spastic paraparesis. Braz J Med Biol Res. 2005 Nov. 38(11):1643-7. [Medline].

  33. Morgan OS, Montgomery RD, Rodgers-Johnson P. The myeloneuropathies of Jamaica: An unfolding story. Quarterly Journal of Medicine. 1988. New Series 67, No 252:273-281. [Medline].

  34. Nagai M, Usuku K, Matsumoto W, et al. Analysis of HTLV-I proviral load in 202 HAM/TSP patients and 243 asymptomatic HTLV-I carriers: high proviral load strongly predisposes to HAM/TSP. J Neurovirol. 1998 Dec. 4(6):586-93. [Medline].

  35. Nakamura T. Immunopathogenesis of HTLV-I-associated myelopathy/tropical spastic paraparesis. Ann Med. 2000 Dec. 32(9):600-7. [Medline].

  36. Olindo S, Cabre P, Lézin A, Merle H, Saint-Vil M, Signate A, et al. Natural history of human T-lymphotropic virus 1-associated myelopathy: a 14-year follow-up study. Arch Neurol. 2006 Nov. 63(11):1560-6. [Medline].

  37. Oliveira JT, Carneiro-Proietti AB, Lima-Martins MV, et al. Erectile insufficiency as first symptom of HTLV I/II associated myelopathy. Case report. Arq Neuropsiquiatr. 1998 Mar. 56(1):123-5. [Medline].

  38. Rodgers-Johnson PE, Garruto RM, Gajdusek DC. Tropical myeloneuropathies-a new aetiology. Trends Neurosci. 1988. 11, No. 12:526-532. [Medline].

  39. Roman GC. Tropical myelopathies and myeloneuropathies. Bulletin Pan Am Am Health. 1987. 21(3):293-305. [Medline].

  40. Roman GC, Spencer PS, Shoenberg BS. Tropical myeloneuropathies: the hidden endemias. Neurology. 1985. 35:1158-1170. [Medline].

  41. Saito M, Eiraku N, Usuku K, et al. ApaI polymorphism of vitamin D receptor gene is associated with susceptibility to HTLV-1-associated myelopathy/tropical spastic paraparesis in HTLV-1 infected individuals. J Neurol Sci. 2005 May 15. 232(1-2):29-35. [Medline].

  42. Shimazaki R, Ueyama H, Mori T, et al. Chronic sensory neuronopathy associated with human T-cell lymphotropic virus type I infection. J Neurol Sci. 2002 Feb 15. 194(1):55-8. [Medline].

  43. Smikle MF, Barton EN, Morgan OC, et al. The significance of immune disorder in tropical spastic paraparesis. Hum Antibodies. 1999. 9(2):133-7. [Medline].

  44. St. Clair Morgan O. The myeloneuropathies of Jamaica. Molecular Neurobiology. 1994. 8:149-153. [Medline].

  45. Taylor GP, Tosswill JH, Matutes E, et al. Prospective study of HTLV-I infection in an initially asymptomatic cohort. J Acquir Immune Defic Syndr. 1999 Sep 1. 22(1):92-100. [Medline].

  46. Touze E, Gessain A, Lyon-Caen O, Gout O. Tropical spastic paraparesis/HTLV-I-associated myelopathy in Europe and in Africa: clinical and epidemiologic aspects. J Acquir Immune Defic Syndr Hum Retrovirol. 1996. 13 Suppl 1:S38-45. [Medline].

  47. van der Ryst E, Smith MS, Visagie HM. Comparison of the polymerase chain reaction and serology for the diagnosis of HTLV-I infection. J Infect. 1996 Mar. 32(2):109-12. [Medline].

  48. Vieira Filho JPB, Oliveira ASB, Da Silva MRD, et al. Polineuropatia nutricional entre indos Xavantes. Rev Ass Med Brasil. 1997. 43(1):82-88. [Medline].

  49. Watanabe T. HTLV-1-associated diseases. Int J Hematol. 1997 Oct. 66(3):257-78. [Medline].

  50. Yata S, Ogawa T, Sugihara S, et al. HTLV-I carrier with unusual brain MR imaging findings. Neuroradiology. 2004 Sep. 46(9):755-8. [Medline].

  51. Zaninovic V. On the etiology of tropical spastic paraparesis and human T-cell lymphotropic virus-I-associated myelopathy. Int J Infect Dis. 1999. 3(3):168-76. [Medline].

Light microscopy of thoracic spinal cord of 2 patients with HTLV-1–associated myelopathy (Klüver-Barrera staining). (Source: Aye et al, 2000, Fig. 1.)
Light microscopy of perivascular inflammatory infiltration in the spinal cord (A, C) and in the brain (B, D) (A, B H&E; C, D Elastica Van Gieson; A, C x400; B, D x200). (Source: Aye et al, 2000, Fig. 2.)
Light microscopy of the middle thoracic spinal cord (A, C, E) and subcortical white matter of the brain (B, D, F). Fibrotic changes are seen even in the capillaries (arrows) (A, B, F H&E; C-E Elastica van Gieson; A, C, D, F x400; B x300; E x100). (Source: Aye et al, 2000, Fig. 3.)
Immunostaining of the infiltrating cells in the thoracic spinal cord (A, C, E) and subcortical white matter of the brain (B, D, F) (A, B UCHL-1 [antibody to CD45RO]; C, D CD8; E, F OPD-4; A-F x150). (Source: Aye et al, 2000, Fig. 4.)
Immunostaining of the infiltrating cells in the thoracic spinal cord (A, C) and subcortical white matter of brain (B, D) (A, B UCHL-1[antibody to CD45RO]; C, D CD8; A-D x160). (Source: Aye et al, 2000, Fig. 5.)
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