Araújo A Q, Leite A C, Dultra S V, Andrada-Serpa M J
HTLV-Associated Neuropathies Research Unit, IOC, Hospital Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
J Neurol Sci. 1995 Apr;129(2):147-51. doi: 10.1016/0022-510x(94)00266-q.
HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is apparently a disease with a chronic evolution without spontaneous remissions. The real profile of its natural history and of the progression of the neurological disability, however, awaits confirmation. We devised the present study to evaluate the progression profile of the neurological disability of HAM/TSP in a series of 43 patients who have never received any kind of previous immune therapy. Patients were divided into different groups according to the duration of their disease. Age, gender and the Kurtzke's disability status scale (DSS) at the time of the first examination were compared. There were no statistically significant differences among groups with different disease duration. The present study suggests that the evolution of the neurological disability in HAM/TSP occurs mainly during the first year of the disease and becomes relatively stable after that. Therefore we speculate that the variable therapeutic success rates observed in many series of the literature could be due to the timing in the beginning of the pharmacological immunosuppression. Probably the therapeutic window in HAM/TSP lies within the first year of the disease. Thus it might be of utmost importance that future therapeutical trials take into consideration the duration of the disease since this factor can play an important role in the results of the trial.
人类嗜T淋巴细胞病毒I型相关脊髓病/热带痉挛性截瘫（HAM/TSP）显然是一种慢性进展性疾病，不会自发缓解。然而，其真实的自然病史和神经功能障碍进展情况仍有待证实。我们开展了本研究，以评估43例从未接受过任何免疫治疗的HAM/TSP患者的神经功能障碍进展情况。根据病程将患者分为不同组。比较了初次检查时的年龄、性别和Kurtzke残疾状态量表（DSS）。不同病程组之间无统计学显著差异。本研究表明，HAM/TSP神经功能障碍的进展主要发生在疾病的第一年，此后相对稳定。因此我们推测，许多文献系列中观察到的不同治疗成功率可能归因于开始药物免疫抑制的时机。HAM/TSP的治疗窗可能在疾病的第一年。因此，未来的治疗试验考虑病程可能至关重要，因为这一因素可能对试验结果产生重要影响。
