Mielopatia associada ao HTLV-1: perfil clínico, epidemiológico e fatores prognósticos de incapacidade para marcha

Abstract

Purpose: to analyze the prevalence of clinical features and epidemiology and to determine the time course of disability for walking and identify predictor factors of outcome among patients with in a sample of HAM/ TSP. Methods: All HAM/TSP patients consecutively admitted from 1998 to 2007 at the Sarah Hospital were included in the study. After cases definition, data were entered retrospectively when the patient was first seen and in each follow-up visit. Statistical analysis was estimated by theKaplan-Meier method. The log rank test was used for univariable analysis (p<0,20) and Cox regression model was utilized for multivariable analysis (p<0,05). Results: 206 patients (67% females; mean age: 53 years old) were diagnosed as having HAM/TSP. The mean time of evolution was 9.0 years. The most common neurological symptoms were a chronic progressive spastic paraparesis, spasticity, pain, neurogenic bladder and neurogenic bowel. The neurological findings were hipereflexya, Babinsky, Hoffman, and peripheral neuropathy. Pain, spasticity and spinal cord MRI atrophy by thoracic spinal cord were associated with time of disease (p<0,05). Sex, blood transfusion, mother and partner seropositive, alcoholism and tabagism did not show statisticalsignificancy. Using the univariable analysis, spasticity, articular limitation into legs, early use of any aid, age > 50 and 60 years-old, and thoracic neurological level were associated to the time of disease. Multivariable analysis showed that early use of aid before three years of disease, age > 60 years-old, articular limitation and thoracic neurological level were predictable factors for wheel chair confinement. Conclusions: HAM/TSP is a very disabling disorder. Spasticity and thoracic spinal cord atrophy onMRI were found in a later phase of the disease. Pain seams to appear earlier. The control of spasticity may contribute to postpone the incapacity for walking in patients with HAM/TSP. Physiotherapy for preventing articular limitations is necessary and older patients must be controlled frequently. Epidemiological and clinical features poorly explain why some patients have a shorter time of disabling than others; therefore, more researches about the interaction between the virus and human systemsare needed. Early treatment is recommedal.