Croda Mariana Garcia, de Oliveira Augusto César Penalva, Vergara Maria Paulina Posada, Bonasser Francisco, Smid Jerusa, Duarte Alberto José da Silva, Casseb Jorge
HTLV Clinic, Institute of Infectious Diseases Emílio Ribas, São Paulo, Brazil.
J Neurol Sci. 2008 Jun 15;269(1-2):133-7. doi: 10.1016/j.jns.2008.01.004. Epub 2008 Feb 6.
The use of corticosteroids for treating tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) has yielded controversial results. We report the use of corticosteroids for the treatment of TSP/HAM in an open cohort.
The clinical efficacy of long-term, high dose of corticosteroid therapy was studied in thirty-nine TSP/HAM patients. Disability and motor dysfunction was evaluated based on the Disability Status Scale (DSS), Osame's Motor Disability Scales (OMDS), and Incapacity Status Scale (ISS), before and after treatment. Treatment included use of methyl-prednisolone, 1 g/day for three days, every 3-4 months. The primary end-point was a change in the scores of the neurological scales from baseline until the fifth visit after therapy.
After a mean follow-up of 2.2 years and an average of four pulses per patient, we noted a significant neurological improvement, reaching 24.5% according to the ISS score. No statistically significant differences in scores according to the OMDS and DSS scales were noted.
We observed neurological improvement with the use of corticosteroids, with physical therapy and antispastic-drugs as adjunctive treatment. However, randomized clinical trials should be done to assess the use of corticosteroids and other potentially useful immune-based therapies for TSP/HAM treatment.
使用皮质类固醇治疗热带痉挛性截瘫/人嗜T淋巴细胞病毒1型相关脊髓病（TSP/HAM）产生了有争议的结果。我们报告在一个开放队列中使用皮质类固醇治疗TSP/HAM的情况。
对39例TSP/HAM患者研究了长期、高剂量皮质类固醇治疗的临床疗效。在治疗前后，根据残疾状态量表（DSS）、小见的运动残疾量表（OMDS）和失能状态量表（ISS）评估残疾和运动功能障碍。治疗包括每3 - 4个月使用甲泼尼龙，1 g/天，连用3天。主要终点是从基线到治疗后第五次随访时神经量表评分的变化。
平均随访2.2年，每位患者平均进行4次脉冲治疗后，我们注意到神经功能有显著改善，根据ISS评分达到24.5%。在OMDS和DSS量表评分方面未观察到统计学上的显著差异。
我们观察到使用皮质类固醇并辅以物理治疗和抗痉挛药物可改善神经功能。然而，应进行随机临床试验以评估皮质类固醇和其他可能有用的基于免疫的疗法在TSP/HAM治疗中的应用。
