Tropical Myeloneuropathies Treatment & Management

Updated: Oct 09, 2020
  • Author: Friedhelm Sandbrink, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
  • Print
Treatment

Medical Care

The mainstay of treatment is symptomatic. No standard treatment is available for tropical ataxic neuropathy (TAN) or HTLV-1–associated myelopathy/tropical spastic paraparesis (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.

Next:

Diet

Tropical ataxic neuropathy (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.

Previous
Next:

Prevention

An important component in care of patients with tropical spastic paraparesis (TSP) is prevention of infection with HTLV-1 virus. Several studies indicate that transmission of the HTLV-1 virus occurs through sexual or other intimate contact (intrauterine, neonatal contact, perinatal exposure via breast milk, sharing of needles by drug abusers, and blood transfusion from infected persons). One study showed that transfusion of HTLV-1 antibody-positive blood causes seroconversion in 60% of recipients. Transfusion of plasma alone in humans did not result in seroconversion. Breastfeeding is contraindicated for mothers who are carriers of HTLV-1.

Previous