Tropical Myeloneuropathies Treatment & Management

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

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.
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Consultations

Infectious disease specialist

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Diet

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.

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