MyelopathyTropical

Myelopathy tropical is a nonstandard, umbrella term used to describe forms of spinal cord disease observed in tropical and subtropical regions. It is not a single disease, but a label for various myelopathies that arise from infectious, inflammatory, nutritional, or parasitic causes more commonly encountered in tropical settings. In medical literature the term often overlaps with conditions such as HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP), onchocerciasis-associated myelopathy (OAM), schistosomal myelopathy from schistosomiasis, and nutritional myelopathies due to vitamin B12 or copper deficiency.

Clinical features typically include gradual or subacute onset of bilateral leg weakness with spasticity, sensory disturbances (especially vibration and proprioception), and bladder dysfunction. Autonomic symptoms such as constipation or urinary urgency may accompany gait impairment. The neurological pattern commonly reflects thoracic or thoracolumbar spinal involvement, but the exact distribution depends on the underlying cause.

Diagnosis relies on a combination of neurologic examination, imaging, and targeted laboratory testing. Magnetic resonance imaging of the spine may show cord atrophy or signal abnormalities, while etiologic workup includes testing for HTLV-1 antibodies (for HAM/TSP), serology for schistosomiasis, assessment for onchocerciasis exposure, and nutritional studies such as vitamin B12 and copper levels. Ancillary tests, cerebrospinal fluid analysis, and the exclusion of compressive lesions are also part of the evaluation.

Management is etiologically driven and often multimodal. Treatments may include antiparasitic or antihelminthic therapy where active infections are identified, nutritional supplementation for deficiencies, and supportive care with physical rehabilitation and management of bladder and bowel symptoms. Immunomodulatory or anti-inflammatory therapies have variable evidence, particularly for HAM/TSP. Prognosis varies by underlying cause and timeliness of intervention, with many patients experiencing progressive symptoms despite treatment and others achieving stabilization with comprehensive care.