Multiple SclerosisKMC Neurology
Overview
Multiple sclerosis (MS) is a chronic, progressive, degenerative disorder that affects nerve fibers in the brain and spinal cord. A fatty substance (called myelin) surrounds and insulates nerve fibers and facilitates the conduction of nerve impulse transmissions.
MS is characterized by intermittent damage to myelin (called demyelination) caused by the destruction of specialized cells (oligodendrocytes) that form the substance. Demyelination causes scarring and hardening (sclerosis) of nerve fibers usually in the spinal cord, brain stem, and optic nerves, which slows nerve impulses and results in weakness, numbness, pain, and vision loss.
Because different nerves are affected at different times, MS symptoms often worsen (exacerbate), improve, and develop in different areas of the body. Early symptoms of the disorder may include vision changes (e.g., blurred vision, blind spots) and muscle weakness.
MS can progress steadily or cause acute attacks (exacerbations) followed by partial or complete reduction in symptoms (remission). Most patients with the disease have a normal lifespan.
Types
Multiple sclerosis is classified according to frequency and severity of neurological symptoms, the ability of the CNS to recover, and the accumulation of damage.
Primary progressive MS causes steady progression of symptoms with few periods of remission.
Relapsing-Remitting MS causes worsening of symptoms (exacerbations) that occur with increasing frequency, along with periods of reduced symptoms (remission).
Secondary progressive MS is initially similar to relapsing-remitting MS and eventually progresses to MS with no remission.
Relapsing-Progressive MS causes accumulative damage during exacerbations and remissions.
Incidence and Prevalence
MS is the most common neurological cause of debilitation in young people and affects about 500,000 people in the United States. Worldwide, the incidence is approximately 0.1%. Northern Europe and the northern United States have the highest prevalence, with more than 30 cases per 100,000 people.
MS is more common in women and in Caucasians. The average age of onset is between 18 and 35, but the disorder may develop at any age. Children of parents with MS have a higher rate of incidence (30-50%).
Risk Factors and Causes
The specific cause of MS is not fully understood. It is usually classified as an autoimmune disease because it is widely accepted that it results from an abnormal immune system response. This response may be triggered by genetic, environmental, and viral factors that may initiate demyelination.
Demyelination is associated with an abnormal immune system response that causes T cells (white blood cells that are produced in bone marrow and develop in the thymus, which is an organ of the immune system) to attack myelin. Damage to the myelin then leads to sclerosis of nerve fibers in the central nervous system (CNS). The CNS has the ability to repair some of the damage but may not be able to achieve complete restoration. Exacerbations and remissions (common in multiple sclerosis) result from the intermittent damage and restoration.
A higher incidence of MS in certain geographical areas, such as the northern United States, suggests that environmental factors may be involved, but none have been identified.
Exposure to a virus may also trigger MS. A viral risk factor has not been identified, but exposure to a virus that causes demyelination (especially prior to adolescence) may be a risk factor.
Signs and Symptoms
The hallmark of multiple sclerosis is unpredictable periods of exacerbation, remission, and progression. Initial symptoms of MS may be brief and mild. The first serious attack usually lasts weeks or months and occurs between the ages of 20 and 40.
The most common early symptoms include sensory abnormalities (e.g., tingling, numbness, itching, tightness, burning, shooting pain in the back and limbs [called Lhermitte's sign]) difficulty walking, eye pain, and vision loss.
Symptoms of the disease vary, depending on where the damage occurs, and range from minor physical annoyances to major disabilities. Common symptoms include the following:
Muscle weakness can involve the extremities (arms and legs) on one side of the body (called hemiparesis), both legs (called paraparesis), or all four extremities (called quadraparesis). Muscles in the affected area may tighten (called spasticity) and contract spontaneously (called spasm or clonus).
Many people with MS experience fatigue and need to rest and sleep during the day in order to continue their activities. The degree of fatigue may not be related to the severity of other symptoms.
An increase in body temperature (e.g., caused by hot weather, hot bath and showers, or fever) can worsen symptoms or produce new ones. This occurs because elevated body temperature slows nerve impulse conduction, especially in demyelinated nerves.
Diagnosis
Diagnosis of MS is based on medical history, physical and neurological examination, blood tests, MRI, spinal tap, and neurological tests.
Blood tests
Blood tests may be used to help rule out other conditions that cause similar symptoms.
Magnetic resonance imaging (MRI)
MRI scan uses a magnetic field to create detailed images of the brain and spinal cord. This imaging test can be used to detect white matter lesions (sclerosis in the ventricles [cavities that contain cerebrospinal fluid]) in the brain.
Spinal Tap
Spinal tap, or lumbar puncture, is performed to detect oligoclonal bands in cerebrospinal fluid. Oligoclonal bands result from elevated levels of the antibody immunoglobulin G (IgG) and myelin basic protein, which is a byproduct of demyelination, and are present in more than 85% of MS cases. In this procedure, a needle is inserted between two lower spine (lumbar) vertebrae and cerebrospinal fluid is collected and analyzed.
Evoked Potential Tests
Evoked potentials are electrical signals generated by the nervous system in response to stimuli. Evoked potential tests (i.e., somatosensory evoked potentials, visual evoked potentials, brainstem auditory evoked potentials) are performed to evaluate sensory, visual, and auditory functions and detect slowed nerve impulse conduction caused by demyelination.
In these tests, nerves responsible for each type of function are stimulated electronically and responses are recorded using electrodes placed over the CNS (brain and spine) and peripheral nerves (e.g., median nerve in the wrist, peroneal nerve in the knee).
Differential Diagnosis
Early signs of MS are often mistaken for other disorders, including the following:
Conditions that may appear similar to MS on MRI include the following:
Treatment
Treatment for multiple sclerosis varies. The goals of treatment are to improve the quality of life by relieving symptoms caused by exacerbations (called palliative treatment), slowing the course of the disease as much as possible, and providing psychological support.
In general, starting treatment early in the course of the disease and continuing treatment indefinitely is thought to provide the most benefit. Health care providers and patients should make treatment decisions together.
Palliative Treatment
Corticosteroids are typically prescribed to treat exacerbations of MS. Methylprednisolone (Solu-Medrol®) is be administered through an IV (intravenously) for 2-7 days, followed by a course of prednisone. Prednisone (Deltasone®) may be given for 10 days then the dosage is gradually reduced over 3 weeks and stopped.
Corticosteroids are usually well tolerated. Side effects include the following:
Treatment for specific symptoms may include the following:
Muscle weakness, numbness, and stiffness (spasticity) may be treated using medication taken regularly or as needed. These drugs include muscle relaxants, such as tizanidine (Zanaflex®) and baclofen (Loresal®), benzodiazepines, such as diazepam (Valium®), and anticonvulsants, such as carbamazepine (Tegretol®).
Side effects of baclofen and tizanidine include drowsiness, dizziness, and fatigue. This drug should not be discontinued abruptly. Carbamazepine may cause severe side effects including aplastic anemia, low white blood cell count (leukopenia), cancer that develops in cells found in blood and lymph (lymphoma), heart failure, and seizures.
Fatigue may be treated using amantadine hydrochloride (Symmetrel®) or modafinil (Provigil®) when frequent napping, adequate sleep at night, and daily exercise do not help. Side effects include nausea, dizziness, and headache.
Balance and equilibrium abnormalities (e.g., difficulty walking, uncoordinated movements, tremor) may be treated using medications such as benzodiazepines (Valium®), clonazepam (Klonopin®), propranolol (Inderal®), and mysoline (Primidone®). Side effects include drowsiness, confusion, and depression.
Bladder dysfunction (e.g., incontinence, nocturia) may be treated using medications such as oxybutynin (Ditropan®), tolterodine (Detrol®), and hyosciarnine (Levsin®). Bladder-emptying regimen, intermittent catheterization, and surgery may also be used. Side effects of medication include headache, dry mouth, constipation, and dizziness.
Constipation may be worsened by inactivity. Treatment includes eating a high-fiber diet, increasing fluid intake, daily exercise, and stool softeners. Rectal suppositories or enemas occasionally may be required.
Sexual dysfunction may occur in men and women with MS. Treatment is available for erectile dysfunction and female sexual dysfunction.
Immune Therapy
This treatment uses medication to change (modify) the immune system's actions involved in relapsing types of MS. Immune therapy may reduce the frequency of exacerbations and the accumulation of damage.
Medications include the following:
Interferon beta-1a (Avonex®) is given into muscle (intramuscular injection) once per week and has been shown to reduce exacerbations and physical disability. Side effects include flu-like symptoms (e.g., malaise, muscle aches, fever) and inflammation (i.e., pain, redness, infection) at the injection site.
Rebif® is an interferon beta-1a that has been shown to delay progression of MS and reduce the frequency of exacerbations. It is administered subcutaneously (under the skin), 3 times per week at a dose of 22 or 44 mcg and dosing frequency maintains a constant concentration of drug in the body.
Rebif is packaged in pre-measured, pre-filled syringes, which may be helpful for patients who have difficulty preparing medication for injection. Side effects include fatigue, inflammation at the injection site, headache, and flu-like symptoms.
Interferon beta-1b (Betaseron®) is given by subcutaneous (under the skin) injection, every other day. It has been shown to reduce the frequency and severity of exacerbations. Side effects include flu-like symptoms (most common during the first few months of use) and inflammation at the injection site.
Glatiramer acetate (Copaxone®) is an amino acid that modifies actions of the immune system that may affect the progression of MS. It has been shown to reduce the frequency of exacerbations and the level of disability. It is given by subcutaneous injection every day and usually is well tolerated. Side effects include chest tightness and palpitations (rapid heart beat).
Psychotherapy
Central nervous system abnormalities associated with MS and the psychological and social impact of the disorder often result in mood swings and depression. MS support groups, counseling, and/or antidepressants (e.g., amitriptyline, clomipramine, nortriptyline) may be helpful.
Rehabilitation
Treatment for MS may also include physical therapy, occupational therapy, and speech therapy. Physical therapy uses exercises to help strengthen muscles, reduce pain and spasticity, and improve balance and walking. Assistive devices (e.g., canes, braces, walkers) may be used to help patients remain as independent as possible.
Occupational therapy increases independent function in activities of daily living that focus on grooming, dressing, eating, driving, and handwriting. Adaptations in the work and home environment (e.g., shower chairs, hand rails, ramps) are based on patient needs.
Speech therapy may be helpful if slurred speech (dysarthria) or difficulty swallowing (dysphagia) develops.
Prognosis
Most people with MS have a relatively normal life span and life expectancy is about 35 years after onset. After 25 years, approximately two-thirds of patients remain mobile. The disorder eventually results in physical limitations in about 70% of patients.
Prevention
There is no established prevention for multiple sclerosis.
Natural Treatments
Chronic diseases like MS can often be managed and sometimes cured more effectively with alternative therapeutics than with conventional medicine. MS patients commonly seek out alternative therapies that aim to reduce inflammation and are based on changes in the diet and lifestyle.
This section will include some of the better known alternative treatments for MS:
Also described are some general guidelines to follow no matter what treatment the MS patient chooses. We will update information as more research data are gathered and the effectiveness of the treatment options can be determined.
Swank Diet
Dr. Roy Swank, Professor of Neurology at University of Oregon Medical School, developed this diet after observing the outcome of a 5-year study conducted by the Montreal Neurological Institute. That study found that MS occurred only in populations that consumed saturated fats as a substantial part of their diet. With the exception of coconut oil, saturated fats can be found in the highest concentrations in animal products such as meats, cheese, milk, butter, etc. In countries with minimal saturated fat consumption (Asia, Africa, Middle East, and most of South America), MS is a relatively rare occurrence.
North America, Western Europe and Argentina (where the economy is founded on the cattle industry) have considerably higher rates of MS than the rest of the world. The authors of the study reported that in Norway, where the population is genetically homogeneous, there was a curious but significant difference in the occurrence of MS, depending on where one lived. For the inland population, where the diet is focused on butter, cheese, milk, other dairy products and meat as a mainstay, MS was 8 times more prevalent than in populations along the coastal shoreline, where the diet was based on deep ocean fish that are high in unsaturated fats. The amount of saturated fat consumed appeared to match the incidence of MS.
Another study conducted shortly afterward discovered the low incidence of MS in Sicily and Southern Italy, where large amounts of unsaturated fats in the form of olive oil and fish are consumed on a daily basis. The relationship between unsaturated fat consumption and low MS rates was too compelling to ignore.
Dr. Swank developed his own study that spanned 35 years and tracked over 150 MS patients. Half of the participants followed the low-fat Swank diet outlined below. The other half continued to consume a standard western diet-one that was high in saturated fat and contained plenty of dairy products and meats. The results were almost unbelievable. During the first 3 years, an 80% reduction of MS exacerbations resulted in the low-fat diet participants. Only 5 % of these patients suffered any deterioration after 35 years.
For those who faithfully followed the low fat diet (72 patients), only 31% had died after 35 years. In contrast, after 35 years, the patients who continued to consume a standard western high fat diet suffered a death rate of 80%. The difference here, even if age, severity of disease before participation in the study, and other confounding factors are taken into account, is astounding.
The Swank diet is more effective when started early on in the course of MS. Later stages and more severe illness do not respond as well.
The guidelines for the Swank diet include:
Anti-inflammatory diet: the modified MacDougall Diet
This diet is named after Professor Roger MacDougall who cured his MS by following the guidelines below. MacDougall lived well into his 80's symptom-free.
Wobenzyme N/proteolytic enzymes
Research has shown the effectiveness of using proteolytic enzyme preparations to treat the inflammatory process responsible for the myelin sheath damage that characterizes MS. Wobenzyme and other proteolytic enzymes are substances that cleave proteins.
In MS, the myelin protective sheath that covers the nerve cells is broken down by immune complexes that are embedded in it. The Wobenzyme N and other proteolytic enzymes break down the destructive immune complexes and can dramatically reduce MS symptoms. While regeneration of damaged tissue is not possible, regular supplementation with enzymes has been documented to halt the progress of degeneration associated with most stages of MS.
In several large-scale clinical trial studies, Wobenzyme N, a German enzyme formula, was found to be more effective than corticosteroids at reducing inflammation with no associated side effects or long-term risk factors.
In addition to the localized effect on the immune complexes embedded in the myelin, there are several other benefits of proteolytic enzyme supplementation:
Bee venom therapy
The Multiple Sclerosis Association of America recently awarded a grant to immunologist Dr. John Santilli to study the effects of bee venom on MS patients.
It is understood that bee venom stimulates immune response with adrenalin and endogenous cortisol release. The exact mechanism for achieving these results is not well understood.The anti-inflammatory constituents, however, have been identified. Melittin is the most abundant of these substances and is known to be 100 times more potent than hydrocortisone.
Bee venom therapy, also known or apitherapy, has a large following of MS patients internationally. Many find it very useful for reducing the common MS symptoms of fatigue, spasm and instability. It is symptomatic treatment, however, and cannot impact the degeneration of neural tissue.
It is essential that allergy to honey bee venom be determined prior to the start of treatment. Allergies to yellow jackets and wasps do not necessarily indicate a honeybee allergy. Careful monitoring by a doctor or experienced beekeeper during the first injections is paramount. Anaphylactic responses can be life threatening. Once allergy has been ruled out, the patient can choose to sting themselves with live bees or inject small amounts under the skin. Live bee venom is thought to be significantly more potent and therapeutic. Most patients insist that the best results require 6 to 10 stings at least twice a week. It is also reported that any noticeable change in symptoms may require several months of consistent treatment.
EAP Supplementation Therapy
Until 1984, it was believed that myelin was just a protective insulation on nerves. Now it is understood that myelin also serves as an electrical shunt to the central axis nerve fiber. In order for it to operate properly as an electrical passageway, certain chemical components need to be present in sufficient quantities. 2-amino ethanol phosphate (EAP) is one of these components. EAP greatly impacts electrical conduction at the cell membrane by protecting the membrane from the immune system aggression that is characteristic of MS. Researchers don't know why, but MS patients have less-than-adequate amounts of EAP.
EAP supplementation therapy works by increasing myelin cell membrane polarity and resistance to immune system aggression. This, in turn, increases electrical conduction capabilities.
Research has shown that EAP can be present in lower-than-average levels throughout the body, not just in the myelin cells, in many MS patients. Lower- than-average electrical discharging in urinary tract tissues may account for the recurrent urinary tract infections and symptoms so often experienced by MS patients. Without enough EAP, the electro-static filter that usually protects the urinary tract from infection does not function optimally, giving rise to microbial invasion and subsequent infections.
Ca-EAP (calcium- EAP) was registered in 1965 by the German Federal Health Authority as effective anti-MS medication, and it is used with positive results at the Hachen Sanitarium, the world's largest MS hospital. However, Ca-EAP has been banned by the FDA in the U.S. for unknown reasons. Many Americans travel to Europe for treatments, where IV injections of EAP are one part of a comprehensive MS protocol that also includes diet and lifestyle changes and nutritional supplementation. The documented results are very positive, and most patients who continue with treatment have no further deterioration of their condition.
General guidelines
Here are some general dietary recommendations that people with MS should follow, no matter what their course of treatment:
Nutritional and botanical supplements for the MS patient include:
The elimination/challenge trial
A good way of determining the impact food may have on symptoms is the time honored "elimination/challenge" trial. This traditional naturopathic procedure has been accurately diagnosing food-related symptoms for many years and continues to be the standard for identifying food sensitivities.
There are 2 ways to approach an elimination/challenge. The first and more difficult but more effective route is outlined as option #1 below. It involves eliminating all the major suspects that usually cause problems and then slowly, over time, adding them back into the diet one-by-one. It provides clear insight into what foods are impacting you in what ways. (The added bonus of this approach is that you may find that there are other foods that, while they are not causing MS, are giving you headaches or insomnia or any other health problem).
The second option is reserved for those who already have a good idea about what foods are problematic for them. The suspected food group is eliminated until symptoms clear and then added back into the diet in order to experience the response or return of symptoms.
Symptoms associated with food challenges may not be the same as the symptoms you were experiencing before you began the elimination process. For example, while you may have experienced chronic sinus pain prior to embarking on your elimination/challenge; you might find that upon challenging the suspect food that your stomach hurts. This doesn't mean the food group being challenged is not causing your sinus pain, rather your body and immune system may react a bit differently when re- introduced to the offending agent.
Some possible symptoms that can occur on a food challenge: headache (may be brief or prolonged), nausea, sleepiness, irritability, depression, anxiety, excitability - feeling "hyper" or "buzzed, stomach ache, sharp abdominal pain, sore throat, stuffy nose, runny nose, itchy nose or eyes, tightness in the chest, skin rash or itching, facial flushing, red ears, muscle twitching or humming or aching, insomnia, fatigue, and apathy. Of course, there are as many ways of manifesting sensitivities as there are people who suffer from them, so be observant.
Elimination/challenge is the most effective way of determining food intolerance. It also provides you with an excellent opportunity to explore and understand your relationship with food more directly.
Option#1
Elimination
Eliminate all suspect foods:
Maintain a diet based on:
If you have a choice, always choose organic. Otherwise, you could be ingesting pesticides, herbicides, fungicides and/or formaldehydes.
Avoid sulfite-containing foods, which most commonly include canned vegetables and fruits, wine, canned tuna (albacore).
Read labels. Know that "vegetable protein" is either wheat or soy; thickening agents and stabilizers are either wheat or corn; and food starch is usually wheat or corn. It is much easier to avoid processed food and faux food while on the diet than to figure out all the additives in prepared foods.
After 2 to 6 weeks of maintaining a strict elimination diet, you should experience a relief from symptoms. You may also lose weight.
Challenge
Begin your challenge with the food group you feel is the least likely culprit. Eat several servings from that food group throughout the day. For example, if you are challenging dairy, have milk with breakfast; include cheese, cream and yogurt in your lunch and dinner menus; drink milk at meals; and snack on dairy items. Then wait. DO NOT continue to add that food group to your diet. You only challenge for one day, then wait for at least 48 hours. Return to eating ONLY your elimination diet foods. If you do not experience a return of symptoms after 48 hours, go on to the next suspected food group. Continue this process until you find the problematic food group. In most cases you will experience a return of symptoms within 48 hours. Rarely do symptoms appear several days or weeks later. If, however, you want to wait more than 48 hours, feel free to do so as this will only increase the accuracy of this type of diagnosis. A week between food group challenges is optimal. Only challenge one food group at a time.
Option #2
Maintain your regular diet, eliminating only the food group that you believe to be causing your symptoms. Eliminate ALL items in that food group for at least 1 month. If your symptoms disappear before the one-month deadline, continue to abstain from that food group for one more week after symptom relief. If, for example, you find yourself symptom-free after just a few days of avoidance, you must still continue to avoid that food group for another week before you can effectively challenge. When you challenge, follow the guidelines stated above: eat several servings of the suspect food group during a 24 period, then return to the elimination diet and wait. More often than not you will get immediate information about how your body is interacting with a problem food group.
Physical Medicine
Exercise is an essential part of all MS treatment plans. Regular gentle exercise can help to maintain flexibility and muscle control and counteract some of the more destabilizing effects of MS.
However, it is easy to overdo it and get discouraged by the discomfort, exacerbation of symptoms, and/or fatigue that can result from too much activity. It is important to find the balance between not enough and too much exercise. Exercise tolerance levels will change from time to time, so persevere and be consistent. Discuss your options with your doctor and explore what feels best.
Common choices for exercise support include: yoga, Tai chi/Qi gong, swimming, bicycling, and walking. Avoid strenuous exercises that can overheat your body's core temperature, as this may exacerbate symptoms.
forrás: http://www.kmcpa.com/neurology/education/multiple_sclerosis.php
A cikkben előkelő helyen szerepel a méhméreg terápia, (bee venom therapy). Terápiás mennyiségnek legalább heti két alkalommal, alkalmanként 6-10 méhszúrást javasol. Ez bele esik a szakirodalomban publikált méhszúrások tartományába. Egy komoly hely, komoly háttérrel. A kiegészítő egyéb terápiái is nagyon figyelemre méltóak és megfelelő felügyelettel alkalmazandóak.
Dr. Körmendy-Rácz János
