Introduction
All over the world, five to ten million people are infected with the
human T-cell lymphotropic virus type1 (HTLV-1) 1),
approximately 0.25% to3.8% of HTLV-1 carriers will develop HTLV-1
associated myelopathy/ tropical spastic paraparesis (HAM/TSP)2). HAM/TSP is a slowly progressive type of myelopathy
and is characterized by spastic paraparesis, bladder and sphincter
dysfunction, and mild sensory impairment. Approximately 80% of patients
with HAM progress slowly after the onset. Nearly 20% of patients with
HAM/TSP progress rapidly after onset and become unable to walk within 2
years, requiring a wheelchair in daily life. The average age at onset is
around 50-year-old, there are few reports of pregnant women with
HAM/TSP.
A nationwide HTLV-1 screening program for pregnant women was started in
2011 in Japan, and we believe that the incidence of HTLV-1 careers will
decrease in the future. Screening for all pregnant women and provision
of information to HTLV-1 careers have been systematized in Japan, there
is little information on pregnancy and childbirth of patients with
HAM/TSP who develop from HTLV-1 carriers.
There are more patients with HAM in women than in men, and several
publications are pointing to early juvenile HAM/TSP. For women with
HAM/TSP in reproductive age and their family, for medical staff, we
think it is important to report pregnancy and childbirth of patients
with HAM/TSP.
We report here of one woman with HAM/TSP and her three consecutive
courses of pregnancy and childbirth without severe complications on her
and her baby. These findings suggest that women with HAM/TSP, even those
who have spastic paraparesis and use a wheelchair in daily life, should
not be discouraged from pregnancy.