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NINDS Researchers Conduct TSP Prevalence Study in Jamaica

For release: Monday, May 16, 1994

Aurora K. Pajeau, M.D.,M.P.H., a clinical associate in the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) will present preliminary findings from the first door-to-door prevalence study of tropical spastic paraparesis (TSP) associated with HTLV-I in Jamaica at the 6th International Conference on Human Retrovirology: HTLV, on Monday, May 16 at 2:45 p.m. at the Marriott Sea View, Absecon, New Jersey.

Dr. Pajeau and colleagues conducted the two-phase door-to-door field study in the remote mountainous areas of St. Catherine Parish, Jamaica, from July to October of 1993. The purpose of the study was to determine the prevalence of and risk factors for TSP in residents of an area reported to have increased HTLV-I seroprevalence.

TSP, a retroviral disease with adult onset, was first recorded in 1888 as Jamaican neuropathy, a neurologic syndrome. TSP appears to be a uniform syndrome worldwide, with minor regional variations. Onset is gradual in more than 60 percent of cases. Back pain, leg weakness, numbness and stiffness, sensations of pins and needles in the feet and burning of the legs or feet, and bladder dysfunction are common symptoms of the condition. Usually one leg is affected more than the other at onset. Other symptoms are constipation and impotence. Progression is typically slow and indolent, sometimes reaching a plateau and remaining at that level for several years. The pathophysiology may be multifactorial in origin.

The study identified 354 persons with difficulty walking. They received neurological examinations and serological tests in their homes. Investigators found a clear association between antibodies for HTLV-I and neurologic symptoms. Preliminary results of this field survey indicated a higher prevalence than previously estimated by passive surveillance techniques.

HTLV-I-associated TSP occurs in endemic form in geographic clusters in island populations throughout the tropics and in southern Japan. It has been reported in the Caribbean islands of Jamaica, Martinique, Guadeloupe, Hispaniola (Dominican Republic and Haiti), Saint Lucia, Barbados, Curaçao, Trinidad and Tobago, as well as in the Seychelles in the Indian Ocean and Tumaco in Colombia.

Tropical myelopathies, which are disorders of the spinal cord and/or nerves, are a significant regional public health problem for developing nations because of the number of disabled individuals and the absence of facilities for diagnosis, care, rehabilitation and job retraining.

"It is our hope that international collaborations like this one will lead to preventive measures to offset the serious effects of tropical myelopathies affecting so many people," said Dr. Pajeau. She added that very few large-scale epidemiologic studies of neurologic diseases have been performed to date in tropical areas due, in part, to a shortage of economic resources. Although recent neuroepidemiologic studies have been initiated in Jamaica, Brazil, Argentina, Colombia, Chile and Ecuador, there has been no door-to-door prevalence data on TSP until this study.

Dr. Pajeau collaborated with researchers from the University of the West Indies in Mona Kingston, Jamaica, Steuart Richards, M.D., Pamela Rodgers-Johnson, M.D., Beverly Cranston, Owen Morgan, M.D., and former NINDS researcher Gustavo C. Roman, M.D.

The NINDS is the nation's principal supporter of research on the brain and nervous system and a lead agency for the Congressionally mandated Decade of the Brain. The Institute supports and conducts a broad program of basic and clinical neurological investigations. The NINDS is part of the National Institutes of Health, located in Bethesda, MD.

Last Modified August 7, 2009