From the Research
Spastic paraparesis is a complex condition with multiple etiologies, including hereditary spastic paraplegia, infectious causes, traumatic spinal cord injury, vascular causes, nutritional deficiencies, and neurodegenerative conditions, and diagnosis requires a comprehensive approach to identify the specific cause. The most common etiologies include multiple sclerosis, hereditary spastic paraplegia, spinal cord compression, and infectious causes such as HIV-associated myelopathy and HTLV-1 associated myelopathy 1. Hereditary spastic paraplegia is a group of genetic disorders affecting corticospinal tracts, with a prevalence ranging from 0.1 to 9.6 subjects per 100,000 reported around the globe 2.
Etiologies of Spastic Paraparesis
- Hereditary spastic paraplegia: a group of genetic disorders affecting corticospinal tracts 3, 4, 2
- Infectious causes: HIV-associated myelopathy, HTLV-1 associated myelopathy, and neurosyphilis 1
- Traumatic spinal cord injury: incomplete injury can result in spastic paraparesis
- Vascular causes: spinal cord infarction and arteriovenous malformations
- Nutritional deficiencies: vitamin B12 deficiency can lead to subacute combined degeneration with prominent spasticity
- Neurodegenerative conditions: primary lateral sclerosis and certain forms of amyotrophic lateral sclerosis may present with spastic paraparesis
Diagnosis and Management
Diagnosis typically requires neuroimaging, laboratory tests, and sometimes genetic testing to identify the specific cause 5. A comprehensive approach to diagnosis and management is essential to improve morbidity, mortality, and quality of life outcomes. The most recent and highest quality study recommends a multidisciplinary approach to diagnosis and management, including physical therapies, oral/intrathecal medications, and surgical interventions 2.