This study will use three different magnetic resonance imaging (MRI) techniques to study
HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/STP)-a disease of slowly
progressive weakness in the legs. It is not known how the HTLV-1 virus causes this disease,
but it is thought that as the body's immune system tries to destroy the virus, parts of the
nervous system-primarily the spinal cord-are damaged.
Patients 18 years of age and older with HAM/TSP and healthy normal volunteers may be
eligible for this study.
Participants will undergo diffusion tensor MRI, MR-spectroscopy, and magnetization transfer
imaging to look at different compositional, architectural, and microscopic properties of the
brain. All of these techniques are similar to conventional MRI, and like the conventional
method they use a strong magnetic field and radio waves to measure structural and chemical
changes in brain tissue. Each of the three scans will be done on separate days, each lasting
about 1 hour. For the procedures, the patient or volunteer lies on a stretcher in a narrow
metal cylinder (the scanner) and is asked to remain still for 15 to 30 minutes at a time. A
special lightweight coil may be placed on the head to enhance the brain images. The subject
can communicate with the person doing the scan at all times.
Magnetic Resonance Imaging (MRI) has become an important tool in the diagnosis of
inflammatory CNS diseases such as Multiple Sclerosis (MS) and HTLV-1 Associated
Myelopathy/Tropical Spastic Paraparesis (HAM-TSP). It is widely used as a marker for disease
activity and progression. However, conventional MRI methods are only suitable to study gross
anatomical features, such as size and shape of a particular area of the brain; questions
regarding intrinsic microstructure and morphologic specificity cannot be addressed. But
axonal damage or structural abnormalities even in normal appearing brain tissue may play an
important role in the development of irreversible disability. Magnetization Transfer
Imaging, Magnetic Resonance Spectroscopy and Diffusion Tensor MRI are imaging techniques
described to be capable of the detection of such changes. Spectroscopy can detect molecular
components in tissue, whereas the Magnetization Transfer Ratio (MTR) allows the measurement
of water-macromolecule interactions. Diffusion Tensor MRI (DT-MRI) is an imaging modality
that combines features of in vivo anatomical MRI and histopathology: it is an in vivo MRI
method that provides information about tissue composition, microstructure, organization and
architecture. This is possible because water diffusion properties in tissues, as measured by
DT-MRI, are affected by tissue constituents, such as macromolecules, membranes, organelles,
as well as by tissue microstructure, architecture and organization. A study comprising
Magnetization Transfer-, Spectroscopy- and DT-MRI furnishes important information that
cannot be obtained using conventional MRI methods.
A. Established Diagnosis of HAM/TSP as defined by Osame, Igata, and Matsumoto and
subsequently confirmed by Gessain and Gout and the WHO.
B. Age 18 or older
C. An initial cohort of 5 HAM/TSP patients with established disease with EDSS levels of
6.0 or greater and duration of disease of 2 years or more will be investigated. If MRI
abnormalities can be demonstrated, the group will be expanded to 20. Of this 20, at least
5 patients have been identified that will be HLA A201.
A. No history of disease of the nervous system or autoimmune disease
B. Age 18 or older
C. Subjects shall be sex- and age-matched to our patients
A subject will be excluded if he/she has a contraindication to MRI scanning such as the
following: Aneurysm clip; Implanted neural stimulator; Implanted cardiac pacemaker or
autodefibrillator; Cochlear implant; Ocular foreign body or implant (e.g. metal savings,
retinal clips); breast implants; or Insulin pumps. Subjects will be excluded if they have
claustrophobia. A pregnancy test will be administered to women of childbearing age.
Pregnant women will be excluded from the studies.