ascorbic-acid and Paraparesis--Tropical-Spastic

We report here the results of therapeutic trials in 200 patients with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) conducted in our department between 1986 and 1993. Motor disability grades were improved by more than one grade in 69.5% (91/131) of patients by oral administration of prednisolone, 50% (3/6) by eperisone hydrochloride only, 43.8% (7/16) by blood purification (lymphocytapheresis and plasmapheresis), 40.0% (2/5) by intrathecal injection of hydrocortisone, 30.0% (3/10) by intravenous injection of high-dose methylprednisolone, 23.3% (10/43) by interferon-alpha (intramuscular injection and inhalation), 22.2% (2/9) by azathioprine, 20.0% (4/20) by high-dose vitamin C, 16.0% (4/25) by erythromycin, 12.5% (3/24) by salazosulfapyridine, 11.8% (2/17) by mizoribine, 7.1% (1/14) by fosfomycin, and 6.3% (1/16) by thyrotropin releasing hormone. No critical side effects of these therapies were seen with the exceptions of one patient with adult respiratory distress syndrome due to cytomegalovirus infection and one patient with drug-induced hepatitis/hepatic failure. Selection of these treatments for patients with HAM/ TSP must be considered on the basis of age, sex, disease severity and complications to reduce adverse events and to improve quality of life. Although the results were a synopsis of different treatments given to 200 patients with HAM/ TSP as an open trial, we consider this the first report of a large-scale therapeutic trial in patients with HAM/TSP. The results of this study indicate that immunomodulatory therapies have some beneficial effects in HAM/TSP, and the functions of these agents are related to the pathophysiology of this disease.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Antiviral Agents; Ascorbic Acid; Azathioprine; Danazol; Erythromycin; Estrogen Antagonists; Female; Fosfomycin; Glycerol; Human T-lymphotropic virus 1; Humans; Hydrocortisone; Immunoglobulins, Intravenous; Immunosuppressive Agents; Injections, Intramuscular; Injections, Intravenous; Injections, Spinal; Interferon-gamma; Leukapheresis; Male; Methylprednisolone; Middle Aged; Paraparesis, Tropical Spastic; Pentoxifylline; Plasmapheresis; Propiophenones; Respiratory Therapy; Ribonucleosides; Sulfasalazine; Thyrotropin-Releasing Hormone; Vasodilator Agents

The aim of this study was to determine the efficacy and safety of intermittent high-dose vitamin C therapy in patients with HTLV-I associated myelopathy (HAM). Seven HAM patients (4 men and 3 women, aged 36 to 81 years), who were repeatedly given a daily oral dose of 1.5 to 3.0 g of vitamin C (40 mg/kg/day) for 3 to 5 successive days followed by a two-day withdrawal period, were followed for a mean period of 9.7 +/- 5.8 months after the therapy. The therapeutic efficacy was evaluated by a 10-grade disability scoring (DS) system, short somatosensory evoked potentials (SSEP) elicited by tibial nerve stimulation and several immunological parameters before and at 2.0 to 14 months after the therapy. All HAM patients responded well to intermittent high-dose vitamin C therapy, 6 being excellent responders (DS improvement > or = 2 grades) and one being a good responder (DS improvement of one grade). The grade of DS was decreased at 9.7 +/- 5.8 months after the therapy from 5.9 +/- 1.6 (baseline) to 3.0 +/- 1.5 (p < 0.01), indicating an excellent clinical outcome. SSEPs were obtained before and after the therapy in 4 of the patients. On SSEP before therapy, all the patients showed abnormally prolonged P37 peak latency. N20 was not recorded in 2 patients. After the therapy, N20 appeared and prolonged P37 peak latency improved in 2 patients. Immunoglobulin concentrations, T-B lymphocyte subsets and HTLV-I antibody titer in serum did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Ascorbic Acid; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Paraparesis, Tropical Spastic

Topics: Ascorbic Acid; Diet; Humans; Japan; Paraparesis, Tropical Spastic

The efficacy of intermittent high-dose vitamin C therapy was evaluated in seven patients with HTLV-I-associated myelopathy (HAM). All HAM patients responded well to this therapy without serious side effects. Grade of disability score improved at 9.7 (SD 5.8) months after the therapy from 7.1 (3.3) to 3.6 (2.0) (p < 0.01). Serum immunosuppressive acidic protein was elevated before and decreased after the therapy from 747 (316) to 398 (86) micrograms/ml (p < 0.05), suggesting favourable immunomodulatory action of vitamin C therapy in HAM patients.

Topics: Adult; Aged; Aged, 80 and over; Ascorbic Acid; Brain; Evoked Potentials, Somatosensory; Female; HTLV-I Antibodies; Humans; Male; Middle Aged; Neoplasm Proteins; Paraparesis, Tropical Spastic