Table 1

Suggested diagnostic criteria for pure hereditary spastic paraparesis and clinical features that would alert the clinician to possible alternative diagnoses

Clinical features
ObligatoryFamily history
Progressive gait disturbance
Spasticity of lower limbs
Hyperreflexia of lower limbs
Extensor plantar responses
CommonParesis of lower limbs
Sphincter disturbances
Mild dorsal column disturbance
Pes cavus
Hyperreflexia of upper limbs
Mild terminal dysmetria
Loss of ankle jerks
UncommonParesis of upper limbs
Distal amyotrophy
Diagnostic alertsParesis greater than spasticity
Prominent ataxia
Prominent amyotrophy
Prominent upper limb involvement
Peripheral neuropathy
Asymmetry
Retinal pigmentation
Extrapyramidal signs