Multiple Sclerosis

DCs Treating the Multiple Sclerosis Patient

By Frank M. Painter|May 29, 2015|Chiropractic Care, Multiple Sclerosis|

DCs Treating the Multiple Sclerosis Patient

SOURCE: ACA News ~ May 2015 ~ FULL TEXT

By Lori A. Burkhart

Multiple Sclerosis (MS) is the most common disabling neurological disease of young adults, according to the National Institutes of Health (NIH), most often appearing when people are between 20 and 40 years old. However, it can also affect children and adults over 40. The U.S. National Library of Medicine defines MS as an autoimmune disease that affects the central nervous system (brain and spinal cord). The myelin sheath, a protective membrane that wraps around the axon of a nerve cell, is destroyed in a patient with MS; this is caused by inflammation. That damage causes nerve signals to slow down or stop. MS affects women more than men.

Since doctors of chiropractic are recognized as primary contact neuromusculoskeletal specialists, most will have patients with undiagnosed MS come into their practices. The DC will diagnose the patient, treat certain symptoms and make the appropriate referrals.

Diagnosis

Diagnosis of MS is complicated in that it can be severe or mild and can go into remission. NIH points out that initial symptoms often are double or blurred vision, red-green color distortion or blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance.

According to Larry Wyatt, DC, DACBR, FICC, professor and senior faculty, division of clinical sciences at Texas Chiropractic College, MS is diagnosed in a number of ways, as its clinical course is distinctive in each patient and there are different types of MS. Some patients with obvious MS are diagnosed by clinical signs and symptoms (i.e., attacks) alone. These patients will have MS attacks that often relapse for months or even years. In other patients further testing is necessary. Magnetic resonance imaging (MRI), often with gadolinium enhancement, is the mainstay of diagnosis in most cases. “Patients with MS will very often have multiple high-signal intensity lesions in the brain and/or spinal cord on T2-weighted images,” Dr. Wyatt says. “In addition, cerebrospinal fluid analysis for immunoglobulin content can be quite helpful. There is a specific set of criteria, called the McDonald Criteria, which outline the findings necessary for the diagnosis of the different forms of MS.”

Jason West, DC, DCBCN, a fourth-generation DC who operates a clinic in Pocatello, Idaho, says the majority of the diagnosis comes from the patient history, but he points out that usually when patients with MS come in, they already are diagnosed and they are unhappy with their medical treatment options. “If they weren’t diagnosed, one of the standards is to do an MRI and look for white lesions, and there is also a spinal tap to look for antibodies,” Dr. West says. “Usually these patients have a history of peripheral neuropathy or neurological disease or processes occurring.”

Symptom Management

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Multiple Sclerosis Puzzle: Vitamin D and the Month of May

The Chiro.Org Blog

SOURCE: MedPage ~ 4-11-2013

By Nancy Walsh, Staff Writer, MedPage Today

Fetal defects in thymic function and inadequate circulating levels of vitamin D may explain the well recognized influence of birth month on risk for multiple sclerosis, British researchers suggested.

Tests for a surrogate marker for thymic output of T cells found about twice the levels in cord blood of autoreactive T cells among individuals born in May compared with those born in November (P=5.5 × 10−5 versus P=1.2 × 10−6), according to Sreeram V. Ramagopalan, DPhil, of the University of Oxford, and colleagues.

Editor’s Note: If you are born in May, you would have been conceived the previous August or September, so the baby would have been carried to term during the low sunlight period of winter.

Mounting evidence has linked MS with vitamin D deficiency, and individuals born in May had lower levels of circulating 25-hydroxyvitamin D, at a mean of 38.4 nmol/L compared with 50.9 nmol/L, P=0.02), Ramagopalan’s group reported in a research letter in the April JAMA Neurology.

The association of birth month with later MS has been observed in many populations, although the phenomenon remains unexplained.

“We hypothesized that birth month influences T-cell production and may impair T-cell central tolerance and/or T-regulatory/T-effector cell balance, predisposing to MS,” the researchers wrote. To test this hypothesis, they examined cord blood from 100 healthy infants, half born in May and the other half in November.

Not only were the numbers of T-cells higher and the vitamin D levels lower in the May cohort, but an inverse correlation also was found between cord blood 25-hydroxyvitamin D and autoreactive CD4+ cells (ρ=−0.37, P=0.009) and CD8+ cells (ρ=−0.04, P=0.004).

These findings, in conjunction with recent observations that genes associated with MS have been found activated in cord blood, support the hypothesis that autoimmune conditions may represent a complex interplay of genetic and environmental factors, according to the researchers. (more…)