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Quantitative assessment of subclinical spasticity in human T-cell lymphotropic virus type I infection

From the Departments of Neurology (Drs. Zunt and Longstreth), Medicine (Division of Infectious Diseases) (Drs. Zunt and Holmes), Epidemiology (Dr. Holmes), and Rehabilitation Medicine (R. Price), and the Center for AIDS and STD (Drs. Zunt, Alarcón, and Holmes), University of Washington School of Medicine, Seattle, WA; and Universidad Nacional Mayor de San Marcos (Dr. Alarcón), Instituto de Ciencias Neurológicas (Dr. Montano), Lima, Perú.

Address correspondence and reprint requests to Dr. J.R. Zunt, Harborview Medical Center, Department of Neurology, Box 359775, 325 Ninth Avenue South, Seattle, WA 98104; e-mail: jzunt{at}u.washington.edu

OBJECTIVE: To compare human T-cell lymphotrophic virus type I (HTLV-I) seropositive and seronegative women for symptoms and signs of spasticity.

BACKGROUND: Infection with HTLV-I causes tropical spastic paraparesis/HTLV-I–associated myelopathy (TSP/HAM). Certain populations, including female commercial sex workers (FSW), are at increased risk of developing this infection. Fewer than 5% of HTLV-I–seropositive persons develop TSP/HAM, which is typically associated with spasticity.

METHODS: Cross-sectional study of 255 registered FSW in Callao, Perú, involving a questionnaire detailing demographics and neurologic symptoms, standard neurologic examination, quantitative assessment of spasticity (QSA) of muscle tone, and serologic testing for HTLV-I. Participants and examiners were blinded to serology results.

RESULTS: On the questionnaire and neurologic examination, none of the 32 HTLV-I–seropositive or 223 seronegative women had signs or symptoms of spasticity. However, mean values on QSA were significantly higher among seropositive women (27.1 Newton-meters/radian [N-m/r]) than among seronegative women (21.6 N-m/r, p = 0.01), indicating a subclinical increase in lower extremity tone. With values of QSA divided into tertiles, and the first tertile serving as the comparison group, the odds ratio for seropositivity was 1.4 (95% confidence interval [CI] 1.0 to 2.0) in the second and 3.1 (95% CI 2.2 to 4.3) in the third tertile, after adjusting for age and place of birth.

CONCLUSIONS: Although a standard neurologic evaluation could not distinguish between women with and without HTLV-I infection, QSA indicated significantly increased lower extremity tone in those with infection. Long-term follow-up will determine whether these subclinical findings in asymptomatic women progress to overt TSP/HAM.

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