People with hereditary spastic paraparesis have exaggerated reflexes, cramps, and spasms, making walking difficult.
Doctors look for other family members who have the disorder, rule out disorders that can cause similar symptoms, and may do genetic tests.
Treatment includes physical therapy, exercise, and drugs to reduce spasticity.
(See also Overview of Spinal Cord Disorders Overview of Spinal Cord Disorders Spinal cord disorders can cause permanent severe problems, such as paralysis or impaired bladder and bowel control (urinary incontinence and fecal incontinence). Sometimes these problems can... read more .)
Hereditary spastic paraparesis affects both sexes and may begin at any age. It affects about 1 to 10 of 100,000 people.
This disorder has many forms and can result from many different types of genetic abnormalities. All forms cause degeneration of the nerve pathways that carry signals from the brain down the spinal cord (to muscles).
More than one area of the spinal cord may be affected.
Symptoms of hereditary spastic paraparesis may begin at any age—from age 1 to old age—depending on the form.
Reflexes become exaggerated, and leg cramps, twitches, and spasms occur, making leg movements stiff and jerky (called a spastic gait). Walking gradually becomes more difficult. People may stumble or trip because they tend to walk on their tiptoes with the feet turned inward. Shoes are often worn down in the area over the big toe. Fatigue is common. In some people, muscles in the arms also become weak and stiff. Sensation and bladder and bowel function are usually not affected.
Usually, symptoms continue to slowly worsen, but sometimes they level off after adolescence. Life span is not affected.
Many forms of hereditary spastic paraparesis damage other parts of the body in addition to the spinal cord. These forms may cause other problems, such as eye problems, lack of muscle control, hearing loss, intellectual disability, dementia, and peripheral nerve disorders Overview of the Peripheral Nervous System The peripheral nervous system refers to the parts of the nervous system that are outside the central nervous system, that is, those outside the brain and spinal cord. Thus, the peripheral nervous... read more .
Exclusion of other disorders with similar symptoms
Identification of family members with the disorder
Sometimes genetic tests
Hereditary spastic paraparesis is diagnosed by excluding other disorders that cause similar symptoms (such as multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more and spinal cord compression Compression of the Spinal Cord Injuries and disorders can put pressure on the spinal cord, causing back or neck pain, tingling, muscle weakness, and other symptoms. The spinal cord may be compressed by bone, blood (hematomas)... read more ) and by determining whether other family members have hereditary spastic paraparesis.
Blood tests to check for the genes that cause the disorder (genetic testing) are sometimes done.
Physical therapy and exercise
A drug to reduce spasticity
Treatment of all forms of hereditary spastic paraparesis focuses on relieving symptoms.
Physical therapy and exercise can help maintain mobility and muscle strength, improve range of motion and endurance, reduce fatigue, and prevent cramps and spasms.
Baclofen (a muscle relaxant) is the drug of choice to reduce spasticity. Alternatively, botulinum toxin (a bacterial toxin used to paralyze muscles or to treat wrinkles), clonazepam, dantrolene, diazepam, or tizanidine may be used.
Some people benefit from using splints, a cane, or crutches. A few people require a wheelchair.