Open AccessEffect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy
Author(s) -
Kevin G Buell,
Aiysha Puri,
Maria Piera Demontis,
Charlotte-Eve Short,
Adine Adonis,
Jana Haddow,
Fabiola Martin,
Divya Dhasmana,
Graham P. Taylor
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0152557
Subject(s) - medicine , methylprednisolone , tropical spastic paraparesis , myelopathy , placebo , human t lymphotropic virus , anesthesia , gastroenterology , surgery , spinal cord , pathology , alternative medicine , psychiatry
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immune mediated myelopathy caused by the human T-lymphotropic virus type 1 (HTLV-1). The efficacy of treatments used for patients with HAM/TSP is uncertain. The aim of this study is to document the efficacy of pulsed methylprednisolone in patients with HAM/TSP. Data from an open cohort of 26 patients with HAM/TSP was retrospectively analysed. 1g IV methylprednisolone was infused on three consecutive days. The outcomes were pain, gait, urinary frequency and nocturia, a range of inflammatory markers and HTLV-1 proviral load. Treatment was well tolerated in all but one patient. Significant improvements in pain were: observed immediately, unrelated to duration of disease and maintained for three months. Improvement in gait was only seen on Day 3 of treatment. Baseline cytokine concentrations did not correlate to baseline pain or gait impairment but a decrease in tumour necrosis factor-alpha (TNF-α) concentration after pulsed methylprednisolone was associated with improvements in both. Until compared with placebo, treatment with pulsed methylprednisolone should be offered to patients with HAM/TSP for the treatment of pain present despite regular analgesia.