Spasticity distribution and severity in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis
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Spasticity distribution and severity in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis Matheus Sales 1,2 & Giselle Bárbara de Almeida Scaldaferri 1 & Juliana Iris Barbosa dos Santos 1 & Ailton Melo 1,3 & Nildo Manoel da Silva Ribeiro 1,2,4 Received: 6 March 2020 / Revised: 15 July 2020 / Accepted: 14 September 2020 # Journal of NeuroVirology, Inc. 2020
Abstract In individuals with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), spasticity is one of the main symptoms. The neurological signs of the disease are well defined, but details of how spasticity appears in these individuals have not been well explored. To describe spasticity location and severity of HAM/TSP individuals. Cross-sectional study with individuals older than 18 years, diagnosed with HAM/TSP and with lower limb spasticity. Pregnant women, individuals with other associated neurological diseases, and those using antispastic drugs were not included. Spasticity was assessed by the Modified Ashworth Scale (MAS), applied to the abductor, adductor, flexor, and extensor muscles of the hips, flexors, and extensors of the knees, dorsiflexors, plantiflexors, evertors, and inverters of the foot. Thirty participants were included. The plantiflexor muscles (90%), knee extensors (80%), knee flexors (63,3%), and adductors (50%) were most frequently affected by spasticity. Twenty-three (76.7%) individuals had mixed spasticity, 5 (16.7%) with distal spasticity and 2 (6.7%) with proximal spasticity. MAS was similar between the lower limbs in at least 6 of the 10 muscle groups of each individual. Spasticity was mostly mixed in the lower limbs, with more frequently mild severity. The individuals were partially symmetrical between the lower limbs. The most affected muscle groups were the plantiflexors, knee extensors and flexors and the hip adductors, consecutively, being predominantly symmetrical. Keywords HTLV-I infections . Tropical spastic paraparesis . HTLV-I-associated myelopathy . Muscle spasticity
Introduction Worldwide, approximately 5 to 10 million people are infected with human T cell lymphotropic virus type I (HTLV-I) (Gessain and Cassar 2012). Brazil is one of the main endemic areas, with Salvador being the city with the
* Matheus Sales [email protected] 1
Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, R. Padre Feijó, 240, Canela Salvador BA 40110-170 Brazil
2
Programa de pós-graduação em Processos Interativos dos Órgãos e Sistemas, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador Brasil
3
Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador Brasil
4
Departamento de Fisioterapia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador Brasil
highest seroprevalence in the country (Galvão-Castro et al. 1997). Despite being mostly asymptomatic, after a few years or decades, the individual can develop serious disea
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