In reply
We thank Lima et al for their interesting comments and questions on our recent study.1 In our cohort, only 3 patients were coinfected with human immunodeficiency virus; subsequently, this parameter has not been analyzed.
Clinical features of HTLV-1–associated HAM/TSP combine paraparesis, sphincter disturbances, and sensory symptoms such as numbness in lower limbs and low back pain. In our study cohort, we used Kurtzke Disability Status Scale (DSS) score to assess patients. We chose strategic end points that were easy to define over the disease course, such as permanent unilateral or bilateral aid in walking, wheelchair confinement, or death related to the disease. Sphincter disturbances were not analyzed in this work. We agree with Lima et al that this symptom plays an important role in HAM/TSP disability. Assignment of a DSS score of 10 may also be directly influenced by urinary dysfunction since urinary tract infections are involved in causes of death. In our cohort, urinary dysfunction constituted the first symptom in 14% of cases, and sphincteric complaints were more prominent than motor impairment in some affected individuals. However, the cross-sectional study of our whole cohort has shown a significant correlation between sphincter disability and DSS score (data not published). Moreover, the natural course of voiding function in HAM/TSP has been studied in 47 patients.2 Similarly to our data, these authors have observed a significant inverse correlation between the age at disease onset and the time to clean intermittent self-catheterization or Foley catheter placement. Thus, the younger patients are at HAM/TSP onset, the longer walking and voiding functions will be maintained.