A spastic paraplegic syndrome in South India

Abstract

Thirty-five cases are described of a condition of spastic paraplegia in South India. Adults of both sexes are affected. The onset is gradual, and most cases are slowly progressive over a limited period. Spastic paraplegia predominates but sensory disturbances occur, and the upper limbs, cranial nerves and brain may be involved. Post-mortem examination of a single case revealed a distinctive widespread disorder of the spinal cord and brain. The condition is indistinguishable both clinically and histologically from the spastic paraplegic form of "Jamaican neuropathy", and may be related to other series reported from many parts of the world. Investigations have excluded all known causes of similar syndromes. It is suggested that the term tropical spastic paraplegia be applied to this disorder, which should be distinguished from tropical ataxic neuropathy. The possible aetiology is discussed, with particular reference to dietary toxins or slow virus infection.