Epidural labour anaesthesia in a patient with tropical spastic paraparesis

Human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM), also called tropical spastic paraparesis (TSP), is a medical condition that is associated with symptoms including muscle spasms, sensory disturbances causing paraparesis, and weakness of the legs. It is estimated that 15-20 million people worldwide are infected with HTLV; however, the majority of individuals will be completely asymptomatic with no clinical signs or symptoms. This is the first case report detailing a patient with suspected seronegative TSP who received epidural analgesia during labour with no change in her neurological symptoms postpartum. The significance of this disease is twofold; TSP has many similarities to multiple sclerosis (MS), which has known possible complications during labour as well as postpartum, and additionally, the increasing prevalence of TSP reflects the importance of increasing awareness of the condition. TSP should not contraindicate neuraxial anaesthesia. Epidural labour analgesia is an acceptable option for patients with TSP. While there is mention in the literature regarding potential exacerbation of TSP postpartum, there are no reports on the safety of epidural anaesthesia for labour in TSP; thus it was felt that this case needed to be described, as TSP and MS share similar progressive neurological characteristics. Research Ethics Board approval was obtained and the patient gave consent for this case report.