Study of amino acid methionine for treatment of myelopathy
John S. James
Reprinted with permission from AIDS Treatment News. Call 1-800-tREAT-1-2 for subscription information or visit their web site at:
A study at Beth Israel Medical Center in New York is recruiting men or women with HIV who also have any two or more of the following symptoms for at least six weeks:
- Numbness in the legs;
- Unsteady, stiff or uncoordinated gait;
- Urinary frequency, urgency or incontinence;
- Erectile impairment;
- Weakness in the legs;
- Stiffness or spasms in the legs;
- Fecal incontinence or retention; or
- Electrical shock upon flexion of the neck.
These symptoms may indicate HIV myelopathy, a disease of the spinal cord which is believed to be quite common in persons with AIDS, although often not diagnosed. It has been estimated that about 10% of persons with AIDS have symptoms of HIV myelopathy, with about 30% having some evidence of the disease.
The symptoms were described in more detail in an article by the principal investigator of the current study, neurologist Alessandro Di Rocco, MD, published by PWAC (PWA Coalition of New York) in 1997.
The disease develops insidiously, and its first symptoms may not be easily recognized. It frequently starts with some difficulty in bladder control. The stimulus to urinate becomes very frequent, and is often accompanies by a sense of ‘urgency’ to urinate. The person with myelopathy may need to urinate every two to three hours and may need to get up from bed several times during the night to void. Another common symptom for men is difficulty in obtaining or maintaining an erection. While there are many reasons for impotence in men with AIDS, myelopathy is certainly one of the least recognized.
As these initial symptoms slowly progress, stiffness in the legs may develop, often accompanied by cramps and spasms. Walking starts to become difficult, and the legs become easily tired and heavy. Later a true weakness with various degrees of paralysis may develop, and in the final stages of the myelopathy there may be a severe paralysis of the legs, with severe spasms and complete loss of control of urinary function with incontinence requiring diapers or catheters.
Loss of control of the anal sphincter may also develop, with ensuing fecal incontinence. At least initially the disease is painless, although in the later stages cramps and spasms may cause serious discomfort and pain. Abnormal sensation like pins-and-needles, numbness or loss of sensation may develop in the legs, but is usually mild and tolerable.
The arms and hands are generally not affected, but the problems in the lower body slowly get worse.
There are reasons to suspect that HIV myelopathy might be due to a deficiency of the amino acid methionine. In an earlier pilot study of oral methionine, seven of the nine patients who completed the study improved; those earliest in the course of the disease did best. That pilot study was not controlled, however, so it is being followed by the current eight-month trial, which will compare methionine to a placebo for three months, after which everyone will receive methionine for the remaining five months.
- Di Rocco A. AIDS-myelopathy: A common and often neglected neurologic complication of AIDS. PWAC NY Newsline. September 1997, pages 24-26.
- Di Rocco A, Tagliati M, Danisi F, Dorfman D, Moise J, and Simpson DM. A pilot study of L-methionine for the treatment of AIDS-associated myelopathy. Neurology. July 1998; volume 51, pages 266-268.
- Di Rocco A and Simpson DM. AIDS-Associated Vacuolar Myelopathy. AIDS Patient Care and STDs. 1998; volume 12, number 6, pages 457-461.