What is Multiple Sclerosis?

Jul 29

Multiple Sclerosis, or MS, is a neurodegenerative disease in which the immune system attacks nerve fibers. Those afflicted with this disease usually live with periods of uncertainty and fear, as the symptoms can flare up without warning, and impair many different neurological functions. It can negatively affect balance, vision, strength, sensation, and even cognition. MS can be remarkably challenging to live with.

How Common is Multiple Sclerosis?

There are nearly 1 million Americans currently living with multiple sclerosis. It occurs in most ethnic groups, but appears to be more common in Caucasians of northern European descent. It is three times more common in women than in men, implying that hormones may play a role in development of the disease. Most MS onset takes place between the ages of 20 and 50, however it can develop at any age. It appears to be more common for people living farther from the equator, for reasons that remain open to debate (1).

What Causes Multiple Sclerosis?

MS is an autoimmune demyelinating disease, in which the immune system attacks the brain and spinal cord neurons. It attacks and destroys myelin, the covering layer around axons, which are projection fibers that neurons use to communicate with each other. Myelin functions to protect axons, and allows them to communicate efficiently.

Myelinated axons are found in pathways that make up the white matter of the nervous system. An MS attack that destroys myelin leaves neurons and axons more vulnerable to degeneration and cell death. Myelin also allows impulses to move through axons at high speeds. When it is damaged, neurons lose the ability to communicate efficiently. The inflammation from an MS attack leaves behind scar tissue called gliosis, which leads to axonal loss and neuronal cell death (2).

Recent studies have also found that MS may also directly attack our synapses, which are the connections between neurons. Not only does this affect the structure of our neurons, but also the connections between them and their ability to communicate (26).

What are the Symptoms of Multiple Sclerosis?

MS can produce myriad symptoms. Some of the more common ones include sensory disturbances, bladder dysfunction, cognitive deficits, and unilateral painless loss of vision. It is also very common to experience double vision, limb weakness, balance deficits, coordination problems, fatigue, and bowel difficulties. All of these can considerably reduce the quality of life in affected individuals. MS can attack virtually any part of the nervous system, and there are endless ways that this condition may present. No two cases of MS are alike (3).

How Does Multiple Sclerosis Affect the Brain?

The clinical symptoms of MS are largely determined by the location of the gliosis within the brain and spinal cord. MS tends to target different areas at different times, and attacks may range from mild to severe. In more mild attacks, not all function in a pathway or system is lost, and the nervous system may be able to repair or rewire around the damage. Not all of the damage from MS will be permanent. It appears that a dynamic balance between brain destruction and brain reorganization is taking place in MS as the brain tries to compensate for the damage from the disease. This balance acts in favor of keeping brain systems functioning effectively.

Unfortunately, there are limits to how much function the brain can reorganize. With enough tissue damage, the brain will not be able to fully compensate and function will be lost. When these systems fail, functional brain reorganization is no longer effective, and symptoms can become permanent (4).

How is Multiple Sclerosis Diagnosed?

There is no single clinical feature or diagnostic test that is sufficient to diagnose MS. The diagnosis is mostly made based on clinical symptoms that relate to dysfunction in the white matter of the brain. MRI studies and analysis of spinal fluid can help confirm the diagnosis (27). Over the years, several sets of criteria have been proposed for the diagnosis of MS, based on lesions being seen in multiple brain regions and at multiple different times (28).

A multiple sclerosis diagnosis is often subclassified based on the frequency of attacks. The pain types of MS are relapsing-remitting-(RR), primary-progressive-(PP), secondary-progressive-(SP), progressive-relapsing-(PR) MS and clinically-isolated syndrome (CIS) (5).

How is Multiple Sclerosis Usually Treated?

There is no cure for multiple sclerosis at this time. Treatment typically focuses on speeding recovery from attacks and slowing the progression of the disease by modulating the immune system.

MS attacks are managed by medications including corticosteroids and plasmapheresis.

A number of medications exist to slow MS progression. Aggressive treatment with these medications early in the disease process can lower the relapse rate, slow the formation of new lesions, and reduce neurodegeneration. Unfortunately, many of the therapies used to treat MS carry significant health risks (29).

Most treatments are aimed at managing symptoms and flares when they occur. Acupuncture, counseling, and physical therapy are often suggested treatment options as well for helping with symptoms.

Many dietary approaches exist to limit the scope of inflammatory attacks and help with rebuilding myelin. One review of research by Esposito et al reviewed many different diet plans those with MS attempt. Despite the limited number of large-scale prospective studies and well-designed clinical trials providing MS-nutritional guidelines, an overall healthy lifestyle profile, with balanced nutrition – to provide an adequate intake of unsaturated fats, unrefined carbohydrates, fibers, anti-oxidants and to correct hypovitaminosis – was recommended. Furthermore, because diet-related comorbidities such as malnutrition, metabolic syndrome, and cardiovascular disease, seem to be related to a decline in physical condition and quality of life in MS patients, accurate nutritional counseling should be required in all cases (6).

Studies have also found that keeping a consistent physical exercise schedule, as well as resistance training, improved MS patient fatigue, function, and balance (7). This shouldn’t be too surprising, since exercising has many benefits for our brain and body, but some people with MS may be afraid to exercise based on their symptom profile.

How is the NeuroRescue Program Different?

We look at Multiple Sclerosis through a broader lens. We attempt to evaluate every aspect of your disorder, and address it from all relevant angles simultaneously.

We first address the immune system by trying to identify triggers and provocative factors for your autoimmune process. We use cutting edge functional medicine neuroimmunology strategies and comprehensive laboratory evaluation to help your immune system function more normally. We assess factors including intestinal barrier permeability, food sensitivities, chemical sensitivities, and hidden infections that may be contributing to your disease process. We look at dietary factors and nutrient deficiencies that may be promoting your immune dysfunction. While these factors are not causal for MS, they increase your body’s level of inflammation and promote immune overreaction. These therapies are not a replacement for medication management, but they have been shown to have beneficial effects on reducing the relapsing rate, inflammatory markers, and improving the quality of life for MS patients (9,10).

Much of our clinical work involves brain rehabilitation using specific eye movement therapies. A research review by Gil-Casas et al has shown specific eye movement dysfunction in patients with MS (8). They found that almost half patients with MS have issues with saccades and pursuits. Saccades are quick movements from target to target, whereas pursuits are holding gaze on a moving target. They found that most of the dysfunction with saccades comes from the eyes not making it all the way to the target, which is called hypometria, and during pursuits the eyes are unable to stay on the target, with jerks of the eyes. Other common findings were nystagmus, where the eyes drift and jerk when looking at targets, and Internuclear Ophthalmoplegia (INO), in which the eyes do not track together in a coordinated manner. These findings promote dizziness, double vision, and balance problems.

Additional research revealed that MS patients showed significantly increased latency in prosaccade tasks (moving the eyes toward a presented target) and significantly worse performance in anti-saccade tasks (moving eyes away from presented targets).

MRI studies showed that Global gray matter volume correlated with saccade and anti-saccade latency, and anti-saccade peak velocity correlates with gray matter atrophy in the left parietal regions, which are frequently implicated in attention tasks (11).

We use infrared eye tracking to evaluate eye movements, known as videonystagmography (VNG) or videooculography (VOG). VOG studies demonstrate that eye movement abnormalities are common in all forms of MS, even at the earliest stages. VOG can be useful to detect demyelinating process before symptoms begin to present, even in absence of characteristic lesions visible on MRI (12).

Many people living with MS struggle with poor balance and gait. Given that MS tends to attack brainstem pathways involved in the vestibular system’s regulation of eye movement, many of the balance disorders seen are of vestibular origin. Research shows that vestibular rehabilitation is effective in improving balance, fatigue perception, activities of daily living and short distance gait in patients with severe multiple sclerosis (13). Coupling balance therapy with eye movement and gaze stabilization exercises has been shown to improve multiple outcomes for people with MS who have impaired balance and fatigue (14).

In every NeuroRescue Program, we focus aggressively on rehabilitation of eye movements and the integration between eye movement, balance, movement, and cognition. By improving function in these systems, we usually see significant improvement in balance, stability, fatigue, and activities of daily living.

We use several different types of direct neurostimulation in the treatment of multiple sclerosis. We may employ electrical therapies such as transcranial direct current stimulation (tDCS). TDCS has been shown to be a safe and effective treatment for fatigue in MS patients (15,16). Incontinence is a common problem in MS. Posterior tibial nerve stimulation has been shown to be an effective therapy for incontinence in multiple sclerosis (17). Functional patterns of electrical stimulation to nerves in the legs has also been demonstrated to increase walking distance, decrease balance disturbances during gait, reduce pain and fatigue, and improve quality of life in MS patients (18).

We may employ photobiomodulation therapies as part of your NeuroRescue Program. Low-level laser therapy has been shown to significantly improve immune modulation in MS patients, by increasing circulating levels of an important inflammatory cytokine, IL-10 (19).

We may employ additional neuromodulation strategies, such as transcranial magnetic stimulation to help decrease your symptoms and improve your function (20). We will likely do this in combination with photobiomodulation, as research shows a synergistic effect between laser therapy combined with TMS to enhance quality of life in MS (21).

We may utilize hyperbaric oxygen therapy to help modulate neuroinflammation (22), or mirror therapy to improve mobility and functionality (23).

We may even have you perform exercises in a virtual reality environment, to decrease your fall risk (24), and improve gait and balance, as well as to enhance cognitive function by improving executive function, as well as visual-spatial abilities, attention and memory skills (25).

Every NeuroRescue Program is different, with your therapies chosen based on your diagnostic testing and the realities of your condition. It is impossible to take a cookie-cutter approach to the treatment of a condition as complex as MS. The therapy plan we develop will be tailored to your unique neurological presentation. Every brain is different, every presentation is unique, and no two treatment plans are alike.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that have been impacted by your multiple sclerosis. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.