**5. Human T-lymphotropic virus type 1 (HTLV-1) associated myelopathy**

HTLV-1 associated myelopathy (HAM) is a slowly progressive thoracic myelopathy characterized by spastic paraplegia with sensory and autonomic dysfunctions [17, 18]. There are many patients in the Kyushu district, the southwest part of Japan, because the prevalence rate of HTLV-1 carriers is high in Kyushu [18]. We found a HAM patient among the family members including a case of SPG3A (**Figure 2**, IV-6).

A 54-year-old man was admitted to our hospital for the further examination of gait disturbance. He first noticed the gait disturbance about 10 years ago. He walked without a heel and had urinary incontinence for 3 years. He pointed out increased deep tendon reflexes of his legs, a positive Babinski sign, and diminished deep sensation of the legs. On examination, increased leg spasticity was observed bilaterally (**Table 1**). Anti- HTLV-1 antibody was positive in both serum and cerebrospinal fluid (CSF). Serum from his healthy 91-year-old father (III-1, **Figure 2**) was also anti-HTLV-1 antibody positive, probably due to blood transfusion. Mild pleocytosis (8/mm<sup>3</sup> ), elevated neopterin (49 pmol/ml), and positive HTLV-1 proviral DNA were observed in his CSF. Whole-exome sequencing of his DNA did not identify pathogenic variants of the SPG3A and other SPG genes. We treated him with oral prednisolone [19], the symptoms did not worsen after that.

**Acknowledgements**

**Author details**

Haruo Shimazaki

Japan

**References**

We greatly appreciate the *ABCD1* gene analysis by Professor Nobuyuki Shimozawa (Division

**Figure 4.** Spinal MRI of the multiple sclerosis patient. T2: T2 weighted image; central cord lesion in C2-C4 (arrow). T1 Gd:

Spastic Paraplegias Due to Non-Traumatic Spinal Cord Disorders

http://dx.doi.org/10.5772/intechopen.71457

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Division of Neurology, Department of Internal Medicine, Jichi Medical University, Tochigi,

[1] Cho TA, Vaitkevicius H.Infectious myelopathies. Continuum (Minneapolis, Minn.). 2012;

[2] Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmunity

[3] Romi F, Naess H. Spinal cord infarction in clinical neurology: A review of characteristics and long-term prognosis in comparison to cerebral infarction. European Neurology.

of Genomics Research, Life Science Research Center, Gifu University).

T1 weighted gadolinium enhancement; mild enhancement of C2-C3 lesion (arrow).

Address all correspondence to: hshimaza@jichi.ac.jp

**18**(6 Infectious Disease):1351-1373

Reviews. 2017;**16**(9):925-936

2016;**76**(3-4):95-98
