Stop Multiple Sclerosis Naturally

Dr Garys MS Treatment System

The healing process is done by using a simple step-by-step method that rehabilitates your immune system and boosts supporting body systems to get rid of all symptoms (and types) of Multiple Sclerosis PLUS re-energizes and purifies your body for maximum health. In the step-by-step Treatment System, you'll learn how my Directed Nutrition method plus a special vitamin regimen will significantly reduce your symptoms and eventually completely rid you of your current condition. The beauty of ALL Natural treatments is that there are NO Side Effects. You won't see a side effect disclaimer associated with my MS treatment because it WILL NOT make anyone sick. All Natural means you save money on costly prescription drugs and you avoid harsh side effects, all while receiving improved benefits fighting MS. Continue reading...

Dr Garys MS Treatment System Overview

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Fatigue In Multiple Sclerosis

Fatigue in multiple sclerosis has been defined by the 1998 Paralyzed Veterans of America Multiple Sclerosis Council for Clinical Practice Guidelines as a subjective lack of physical and or mental energy that is perceived by the individual or caregivers to interfere with usual or desired activities.

Multiple Sclerosis Like Lesions

Multiple sclerosis (MS) is a clinical diagnosis that should never be made using neuroimaging alone. In 78-95 of clinically diagnosed MS patients, gadolinium-enhanced magnetic resonance imaging (MRI) features include ovoid periventricular, infratentorial, temporal lobe, and corpus callosum white matter lesions that are isointense to hypointense on Tl-weighted images, and show high intensity on proton density and T2-weighted images. Many conditions have to be taken into account in the differential diagnosis of multiple white matter high-signal abnormalities on proton density and T2-weighted images. Other conditions may produce lesions with or without enhancement, and can occur in a patient population similar to that with MS. The list of diseases with clinical and neuroimaging features similar to those of multiple sclerosis includes the following. CSF cerebrospinal fluid CNS central nervous system MRI magnetic resonance imaging MS multiple sclerosis.

Demyelinating Disease 911 Multiple Sclerosis

Multiple Sclerosis Gadolinium

T2-weighted and fluid-attenuated inversion-recovery (FLAIR) images are sensitive for depicting focal lesions in patients with multiple sclerosis (MS), but lack histopathologic specificity. Other lesions such as inflammation, edema, demyelination, remyelination, reactive gliosis and axonal loss have an MR appearance similar to MS lesions and can often not be distinguished from MS 1 . Hypointense T1 lesions in MS are usually caused by matrix destruction and loss of axons 2 . These lesions, which are hypointense on T1-weighted images and have a low magnetization transfer ratio (MTR), correlate better with clinical disability than proton density T2 lesions. A low MTR in hypointense lesions on T1-weighted images has in one study been related to clinically more severe MS 3 . Decreased magnetization transfer ratio is, however, also observed in normal-appearing white matter in MS patients 4 . Multiple sclerosis plaques usually show hyper- or isointensity on diffusion-weighted (DW) images,...

Multiple sclerosis

Multiple sclerosis is an inflammatory demylinating disease directed at the brain and spinal cord characterized by lesions that are due to the perivascular infiltration of monocytes and lymphocytes into the brain parenchyma, brain stem, optic nerve, and spinal cord. There is evidence that its etiology might be viral in origin but the data are inconclusive. The resulting demyelination leads to impaired nerve signaling and subsequent impairment in vision, sensation, movement, and cognition. Multiple sclerosis lesions tend to be focal, and therefore the symptoms are often discretely tied to a particular body region, and multiple symptoms may occur in a single patient. Multiple sclerosis primarily affects adults, with a typical age of onset between 20 and 50 years. An estimated 300 000 individuals in the USA are afflicted with multiple sclerosis. While a relationship between multiple sclerosis risk and latitude exists in North America, Australia, and New Zealand, this is not consistent....

Conventional Medical Therapy for MS

Because of the positive effects of the FDA-approved medications, all people with MS should be strongly considered for treatment with one of these drugs. A 1998 statement by the National Multiple Sclerosis Society emphasized the importance of treatment. The statement recommended that treatment with these medications should be started soon after an MS diagnosis is made and should be considered in all people with MS, regardless of age, rate of relapses, and level of disability.

Information About CAM and MS

For CAM in general, the information available to the general public is vast but of variable quality. For CAM that is relevant to MS, the amount of information is limited and the quality also is variable. To attempt to understand the type of information that is available on CAM and MS, we conducted an informal survey of the popular literature on CAM at the Rocky Mountain Multiple Sclerosis Center. At two local bookstores, we found 50 CAM books written for a lay audience. Two-thirds of these books had sections on MS. In some books, MS was incorrectly defined as a form of muscular dystrophy. Other books made the erroneous and potentially dangerous statement that, because MS is an immune disorder, it is important to take supplements that stimulate the immune system. In fact, MS is an immune disorder, but it is characterized by an excessively active immune system thus, immune-stimulating supplements actually may be harmful. On average, the CAM books recommended five or six therapies for...

Website Focused on CAM and MS

This book was written to provide objective, MS-relevant CAM information to people with MS. Also, because the area of CAM is changing rapidly, we developed a website devoted to CAM and MS at the Rocky Mountain Multiple Sclerosis Center. This site, www.ms-cam.org, is updated regularly and has interactive features. This site has several missions

Matter of Perspective

Alexander Burnfield, an English psychiatrist who has MS, wrote a book entitled Multiple Sclerosis A Personal Exploration. With reference to evening primrose oil, he states I started taking it before the research was published and, being only human, take it just in case I get worse if I stop. This is, I know, an unscientific and emotional response, and the logical-doctor part of me is quite shocked (16). Dr. Elizabeth Forsythe, also an English physician with MS, wrote Multiple Sclerosis Exploring Sickness and Health. With reference to diet and MS, she states It is what you feel in your own body and mind that is the most important thing, and it is very easy for doctors and patients to forget that. I believe that a little of what you fancy does do you good (17).

Additional Readings Websites

CAM website of the Rocky Mountain Multiple Sclerosis Center Bourdette D, Yadav V, Shinto L. Multiple sclerosis. In Oken BS, ed. Complementary Therapies in Neurology An Evidence-Based Approach. New York Parthenon Publishing Group, 2004, 291-302. Burnfield A. Multiple Sclerosis A Personal Exploration. London Souvenir Press, 1997. Forsythe E. Multiple Sclerosis Exploring Sickness and Health. London Faber and Faber, 1988. Kalb RC. Multiple Sclerosis The Questions You Have The Answers You Need. New York Demos Medical Publishing, 2004. Polman CH, Thompson AJ, Murray TJ, et al. Multiple Sclerosis The Guide to Treatment and Management. New York Demos Medical Publishing, 2006. Schapiro RT. Managing the Symptoms of Multiple Sclerosis. New York Demos Medical Publishing, 2003. medicine use among adults United States, 2002. Adv Data 2004 343 1-20. Berkman CS, Pignotti MG, Cavallo PF, et al. Use of alternative treatments by people with multiple sclerosis. Neurorehab Neural Repair...

Placebos and the Placebo Effect

As would be expected, a placebo effect occurs in studies of people with multiple sclerosis (MS). A notable response to placebos has been observed in studies of therapy for MS itself, as well as for MS-related symptoms. In older MS studies, from 1935 to 1950, a variety of ineffective therapies produced 60 to 70 percent improvement. More recently, trials with chemotherapy drugs in MS showed a placebo effect on the rate of MS attacks. In recent research studies using interferon beta-1b (Betaseron), the first U.S. Food and Drug Administration (FDA)-approved immune therapy for MS, the number of MS attacks was determined for people taking Betaseron and for another group taking placebo. The placebo-treated group had a 28 percent decrease in the rate of MS attacks. Similarly, the placebo group showed decreased attack rates of 33 percent in trials using intramuscular interferon beta-1a (Avonex), 13 percent in trials with subcutaneous interferon beta-1a (Rebif), and 43 percent in trials with...

Additional Readings Books

Brown RF, Tennant CC, Dunn SM, et al. A review of stress-relapse interactions in multiple sclerosis important features and stress-mediating and -moderating variables. Mult Scler 2005 11 477-484. Chelmicka-Schorr E, Arnason BG. Nervous system-immune system interactions and their role in multiple sclerosis. Ann Neurol 1994 36 S29-S32. Hirsch RL, Johnson KP, Camenga DL. The placebo effect during a double blind trial of recombinant alpha2 interferon in multiple sclerosis patients immunolog-ical and clinical findings. Neuroscience 1988 39 189-196. La Mantia L, Eoli M, Salmaggi A, et al. Does a placebo-effect exist in clinical trials on multiple sclerosis Review of the literature. Ital J Neurol Sci 1996 17 135-139.

Important Precautions About ementary and Alternative Medicine and

This book provides much detailed information about specific types of complementary and alternative medicine (CAM). This information is intended to assist people in assessing CAM therapies for multiple sclerosis (MS). In addition to this specific information, some general ideas are important to understand and may be helpful in the CAM decision-making process

Malformations of the axis

These lesions may be misdiagnosed as multiple sclerosis (31 ), syringomyelia or syringobulbia (18 ), tumor of the brain stem or posterior fossa (16 ), lesions of the foramen magnum or Arnold-Chiari malformation (13 ), cervical fracture or dislocation or cervical disk prolapse (9 ), degenerate disease of the spinal cord (6 ), cerebellar degeneration (4 ), hysteria (3 ), or chronic lead poisoning (1 ).

Additional Resources Books

An investigation into the management of the spasticity experienced by some patients with multiple sclerosis using acupuncture based on traditional Chinese medicine. Compl Ther Med 1996 4 58-62. Xi L, Zhiwen L, Huayan W, et al. Preventing relapse in multiple sclerosis with Chinese medicine. J Chin Med 2001 66 39-40.

Additional Readings Journal Articles

Neurol 2006 66 572-575. Hunter AL, Rees BW, Jones LT. Gluten antibodies in patients with multiple sclerosis. Human Nutr-Appl Nutr 1984 38 142-143. Jones PE, Pallis C, Peters TJ. Morphological and biochemical findings in jejunal biopsies from patients with multiple sclerosis. J Neurol Psych 1979 42 402-406. Oro AS, Guarino TJ, Driver R, et al. Regulation of disease susceptibility decreased prevalence of IgE-mediated allergic disease in patients with multiple sclerosis. J Allergy Clin Immunol 1996 97 1402-1408. Tang L, Benjaponpitak S, DeKruyff RH, et al. Reduced prevalence of allergic disease in patients with multiple sclerosis is associated with enhanced IL-12 production. J Allergy Clin Immunol 1998 102 428-435.

Studies in MS and Other Conditions

Aromatherapy has not been systematically studied in people with multiple sclerosis (MS). A small preliminary study of two people with MS reported that a treatment program of aromatherapy and massage led to improvement in mobility, dressing ability, and personal hygiene (1). Studies of olfaction in MS indicate that 10 to 20 percent of people with the disease have an impaired sense of smell.

Olfactory Disturbances Dysosmia

Cirrhosis And Cerebral Edema

Unilateral anosmia may be caused by a tumor (meningioma). Korsakoff syndrome can render the patient unable to identify odors. Viral infections (influenza), heavy smoking, and toxic substances can damage the olfactory epithelium trauma (disruption of olfactory nerves, frontal hemorrhage), tumors, meningitis, or radiotherapy may damage the olfactory pathway. Parkinson disease, multiple sclerosis, Kallmann syndrome (congenital anosmia with hypogonadism), meningoen-cephalocele, albinism, hepatic cirrhosis, and renal failure can also cause olfactory disturbances.

Supranuclear and Internuclear Oculomotor Disturbances

Praepositus Nucleus

Internuclear ophthalmoplegia (INO) is characterized by inability to adduct one eye, combined with nystagmus of the other, abducted eye (dissociated nystagmus), on attempted lateral gaze. It is due to a lesion of the medial longitudinal fasciculus (MLF) on the side of the nonadducting eye and at a level between the nuclei of CN III and CN VI. Bilateral MLF lesions cause bilateral INO. Both eyes can adduct normally during convergence. More rostral lesions lead to convergence paresis without nystagmus more caudal lesions lead to paresis of the lateral rectus muscle. Multiple sclerosis and vascular disorders are the most common causes of INO. Unilateral pontine lesions cause ipsilateral gaze palsy (the gaze points away from the side of the lesion) but leave vertical eye movement largely intact. Co-involvement of the MLF leads to one-and-a-half syndrome (ipsilateral pontine gaze palsy + INO), e. g., paresis of conjugate gaze to the left and impaired adduction of the left eye on looking to...

Biology of microglia

These areas are concentrated around the subven-tricular zones where active neurogenesis occurs. These ameboid tissue macrophages then migrate throughout the entire brain parenchyma and differentiate into resident microglial cells. In the mature CNS, microglia are ubiquitously present as highly ramified cells (resting microglia) 5,6 . They respond to changes in the CNS microenvironment in a variety of disorders with or without the participation of the systemic monocytes. Although in degenerative disorders such as AD and Parkinson's disease there is little evidence to support recruitment of monocytes from the periphery, in infectious and autoimmune diseases such as HIVE and multiple sclerosis (MS) and in stroke, there is frank infiltration of monocyte-derived macrophages as well as other inflammatory cells. Even in these diseases in which monocytes are known to contribute significantly to the disease process, studies using sensitive markers of...

Herbs Contain Many Different Chemicals

Many chemicals with beneficial activity against disease have been identified in herbs. It is estimated that 25 percent of prescription drugs and 60 percent of over-the-counter drugs are derived from plants. Well-known examples of these drugs are digitalis, which is derived from the foxglove plant, and quinine, which is derived from South American Peruvian bark. Steroids, which are used to treat multiple sclerosis (MS) attacks, have a very specific chemical structure. Chemicals with steroid-like structures and biologic effects have been identified in Asian ginseng (ginsenoside) and in licorice (glycyrrhizic acid).

Pics Of Spinal Sclerosis

Intraspinal Stimulator

Mycoplasma, neu-roborreliosis, abscess (epidural, intramedul-lary), tuberculosis, parasites (echinococcosis, cysticercosis, schistosomiasis), fungi, neurosyphilis, sarcoidosis, postinfectious myelitis, multiple sclerosis neuromyelitis optica (Devic syndrome), acute necrotizing myelitis, connective tissue disease (vasculitis), paraneoplastic myelitis, subacute myelo-optic neuropathy (SMON), arachnoiditis (after surgical procedures, myelo-graphy, or intrathecal drug administration).

Causes of Horners Syndrome

E.g., dorsolateral pontine lateral medullary or Wallenberg's syndrome E.g., multiple sclerosis Significance The Marcus Gunn pupillary reaction is thought to be due to a reduction in the number of the fibers serving the light reflex on the affected side. The lesion must be prechiasmal, and almost always involves the optic nerve, often due to multiple sclerosis. Significance The condition is seen in normal individuals in cases of hysteria and is associated with incipient cataracts, multiple sclerosis, meningitis, contralateral cerebrovascular insults, and recovery from oculomotor paralysis.

Coffee and Other Caffeine Containing Herbs and Supplements

The largest study to date was conducted by the Rocky Mountain Multiple Sclerosis Center the results of this study have been published in a preliminary form (1) and may be viewed at www.ms.cam.org, the CAM website of the Rocky Mountain MS Center. This study was an online survey that involved nearly 2,000 people with MS. Those who appeared to have MS fatigue were questioned about the various conventional and unconventional therapies that they had tried. For the respondents, about 50 percent believed that some form of caffeine was helpful for their fatigue. Another MS study that included caffeine involved a therapy known as Prokarin the results of this study are difficult to interpret for several reasons, including the fact that Prokarin contains caffeine as well as histamine (see the chapter on Prokarin).

Vitamins Minerals and Other Nonherbal Supplements

The use of vitamins, minerals, and other supplements is both popular and controversial. Surveys of people with multiple sclerosis (MS) indicate that the use of supplements is one of the most common forms of complementary and alternative medicine (CAM). Much of their popularity probably is due to their accessibility. Supplements are easily purchased from grocery stores, health food stores, and drug stores, and using supplements does not require seeing a practitioner.

Practical Information

Pathways Exercise Video for People with Limited Mobility is a video showing yoga poses designed for people with MS. Information about the southern California yoga and MS program may be obtained from the southern California chapter of the National Multiple Sclerosis Society at www.nationalmssociety.org CAL home or 2440 S. Sepulveda Boulevard, 115, Los Angeles CA 90064 (800-344-4867 or 310-479-4456). General information on yoga is available from several yoga organizations

Face and Head Neuralgias

Trigeminal neuralgia The second and third divisions are most commonly involved, and the attacks have trigger points. The symptom may be due to tumors, inflammation, vascular anomalies or aberrations, and multiple sclerosis. Trigeminal neuralgia is the most frequent of all forms of neuralgia

Complementary and Alternative Medicine and MS

Berkman CS, Pignotti MG, Cavallo PF, et al. Use of alternative treatments by people with multiple sclerosis. Neurorehab Neural Repair 1999 13 243-254. 6. Marrie RA, Hadjimichael O, Vollmer T. Predictors of alternative medicine use by multiple sclerosis patients. Mult Scler 2003 9 461-466. 7. Stuifbergen AK, Harrison TC. Complementary and alternative therapy use in persons with multiple sclerosis. Rehab Nursing 2003 28 141-147. 8. Nayak S, Matheis RJ, Schoenberger NE, et al. Use of unconventional therapies by individuals with multiple sclerosis. Clin Rehabil 2003 17 181-191. 9. Shinto L, Yadav V, Morris C, et al. Demographic and health-related factors associated with complementary and alternative medicine (CAM) use in multiple sclerosis. Mult Scler 2006 12 94-100. 11. Hooper KD, Pender MP, Webb PM, et al. Use of traditional and complementary medical care by patients with multiple sclerosis in South-East Queensland. Int J MS Care 2001,3 13-28. 12. Page SA, Verhoef MJ, Stebbins RA, et...

Placebos and Psychoneuroimmunology

The placebo effect during a double blind trial of recombinant alpha2 interferon in multiple sclerosis patients immunological and clinical findings. Neurosci 1988 39 189-196. 4. Brown RF, Tennant CC, Dunn SM, et al. A review of stress-relapse interactions in multiple sclerosis important features and stress-mediating and -moderating variables. Mult Scler 2005 11 477-484. 5. Mohr DC, Hart SL, Julian L, et al. Association between stressful life events and exacerbation in multiple sclerosis a meta-analysis. Br Med J 2004 328 731-735.

Cooling Therapy

Capell E, Gardella M, Leandri M, et al. Lowering body temperature with a cooling suit as symptomatic treatment for thermosensitive multiple sclerosis patients. Ital J Neurol Sci 1995 16 533-539. 2. Flensner G, Lindencrona C. The cooling-suit a study of ten multiple sclerosis patients' experience in daily life. J Adv Nurs 1999 29 1444-1453.

Diets and Fatty Acid Supplements

Multiple sclerosis twenty years on low fat diet. Arch Neurol 1970 23 460-474. 2. Swank RL, Dugan BB. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet 1990 336 37-39. 4. Miller JHD, Zilkha KJ, Langman MJS, et al. Double-blind trial of linoleate supplementation of the diet in multiple sclerosis. Br Med J 1973 1 765-768. 5. Bates D, Fawcett PRW, Shaw DA, et al. Polyunsaturated fatty acids in treatment of acute remitting multiple sclerosis. Br Med J 1978 2 1390-1391. 6. Paty DW, Cousin HK, Read S, et al. Linoleic acid in multiple sclerosis failure to show any therapeutic benefit. Acta Neurol Scand 1978 58 53-58. 7. Dworkin RH, Bates D, Millar JHD, et al. Linoleic acid and multiple sclerosis a reanalysis of three double-blind trials. Neurology 1984 34 1441-1445. 8. Bates D, Fawcett PRW, Shaw DA, et al. Trial of polyunsaturated fatty acids in non-relapsing multiple sclerosis. Br Med J 1977 10 932-933. 10. Bates D, Cartlidge NEF, French JM, et...

Hippotherapy and Therapeutic Horseback Riding

Hammer A, Nilsagard Y, Eorsberg A, et al. Evaluation of therapeutic riding (Sweden) hippotherapy (United States). A single-subject experimental design study replicated in eleven patients with multiple sclerosis. Physiother Theory Prac 2005 21 51-77. 2. MacKay-Lyons M, Conway C, Roberts W. Effects of therapeutic riding on patients with multiple sclerosis a preliminary trial. Proceedings of the 6th International Therapeutic Riding Congress 1988 8 173-178.

Magnets and Electromagnetic Therapy

Pulsing electromagnetic field therapy of multiple sclerosis by the Gyuling-Bordas device double-blind, cross-over and open studies. J Bioelec 1987 6 23-35. 3. Richards TL, Lappin MS, Acosta-Urquidi J, et al. Double-blind study of pulsing magnetic field effects on multiple sclerosis. J Alt Complement Med 1997 3 21-29. 4. Lappin MS, Lawrie FW, Richards TL, et al. Effects of a pulsed electromagnetic therapy on multiple sclerosis fatigue and quality of life a double-blind, placebo controlled trial. Alt Ther 2003 9 38-48.

Antioxidant Vitamins Generally Vitamins A C and E

Among all categories of dietary supplements, antioxidant vitamins were among those used most frequently by a large group of people with MS who were surveyed through a study at the Rocky Mountain Multiple Sclerosis Center (the full results of this survey may be seen at www.ms-cam.org). Antioxidant vitamins include

Studies of MS and Other Conditions

The effects of prayer and spirituality on multiple sclerosis (MS) have not been rigorously studied. One frequently described case of MS that appeared to respond dramatically to prayer and faith involved Rita Klaus. Klaus was a nun who was diagnosed with MS in 1960, at the age of 20. Because of the effects of her illness, she was given dispensation of her vows and left the convent. She eventually married and had three children. At the Rocky Mountain Multiple Sclerosis Center, we conducted a survey of spirituality and prayer in more than 1,000 people with MS. The vast majority of the respondents (90 percent) stated that they believed in God. Within this group, more people (43 percent) believed that God did not play a role in their having MS than believed that God did play a role (28 percent). Of those who believed God played a role in their having MS, a very small percentage (3 percent) thought that MS was a punishment from God. The majority (90 percent) of those who thought that God...

Hyperbaric Oxygen

Hyperbaric oxygen treatment of multiple sclerosis. A randomized, placebo-controlled, double-blind study. N Engl J Med 1983 308 181-186. 2. Kleijnen J, Knipschild P. Hyperbaric oxygen for multiple sclerosis review of controlled trials. Acta Neurol Scand 1995 91 330-334. 3. Bennett M, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. Cochrane Database Syst Rev 2004 (1) CD003057. 4. Neubauer RA, Neubauer V Gottlieb SF The controversy over hyperbaric oxygenation therapy for multiple sclerosis. J Amer Phys Surgeons 2005 10 112-115.

Music Therapy

Active music therapy in the treatment of multiple sclerosis patients a matched control study. J Music Ther 2004 61 225-240. 2. Lengdobler H, Kiessling WR. Group music therapy in multiple sclerosis initial report of experience. Psychother Psychosom Med Psychol 1989 39 369-373. 3. Wiens ME, Reimer MA, Guyn HL. Music therapy as a treatment method for improving respiratory muscle strength in patients with advanced multiple sclerosis a pilot study. Rehabil Nurs 1999 24 74-80.

Acupuncture and Traditional Chinese Medicine

Spoerel WE, Paty DW, Kertesz A, et al. Acupuncture and multiple sclerosis. CMA Journal 1974 110 751. 3. Smith MO, Rabinowitz N. Acupuncture treatment of multiple sclerosis Two detailed clinical presentations. Am J Acupuncture 1986 14 143-146. 4. Miller RE. An investigation into the management of the spasticity experienced by some patients with multiple sclerosis using acupuncture based on traditional Chinese medicine. Compl Ther Med 1996 4 58-62. 5. Steinberger A. Specific irritability of acupuncture points as an early symptom of multiple sclerosis. Am J Chinese Med 1986 14 175-178. 7. Wang Y, Hashimoto S, Ramsum D, et al. A pilot study of the use of alternative medicine in multiple sclerosis patients with special focus on acupuncture. Neurology 1999 52 A550. 8. Xi L, Zhiwen L, Huayan W, et al. Preventing relapse in multiple sclerosis with Chinese medicine. J Chin Med 2001 66 39-40. 9. Yi S, Xiaoyan L. A review on traditional Chinese medicine in prevention and treatment of multiple...

Energy Therapies

This book would not have been possible without the support of the Board of Directors, as well as Karen Wenzel, Executive Director, and other staff at the Rocky Mountain Multiple Sclerosis Center. Dr. Ronald S. Murray encouraged development of this project in the early stages. Thomas Stewart, J.D., PA.-C., M.S., played an important role by devoting time and energy to the research and by providing creative input. Patricia Kennedy, R.N., C.N.P, and Lee Shaughnessy read the initial manuscript carefully and made valuable suggestions. Research assistance was provided by Lee Shaughnessy, Dr. Ragaa Ibrahim, and Julie Lawton for the first edition and by Kathy Haruf for the second edition. I thank the users of www.ms-cam.org, the CAM website of the Rocky Mountain Multiple Sclerosis Center. Users of this website have generously participated in our surveys, which allow us to research the types of CAM

Medicine CAM

Multiple sclerosis (MS) is a common disease of the nervous system. Most people with MS use some form of conventional medical treatment. In addition, many people with MS also use complementary and alternative medicine (CAM), which refers to unconventional medical practices that are not part of mainstream medicine. Despite the fact that CAM is used frequently and MS is a common neurologic disorder, it may be difficult to obtain accurate and unbiased information specific to the use of CAM for MS.

CAM Use in MS

Several studies have evaluated CAM use in MS. One of the earliest studies was conducted in Massachusetts and California in the 1990s (5). Approximately 60 percent of people had used CAM, and, on average, people used two to three different types of CAM. We conducted a similar survey, in 1997, at the Rocky Mountain Multiple Sclerosis Center and found that approximately two-thirds of those who responded to the survey used CAM.

Acupuncture

It is surprising how few studies have evaluated acupuncture in multiple sclerosis (MS). In 1974, a Canadian study of eight people with MS showed that a few had some mild and brief benefits (2). However, there did not appear to be long-lasting effects. In 1986, a very small study of two people with MS showed that multiple MS symptoms improved (3). A recent preliminary study indicates that acupuncture may improve MS-related bladder difficulties. Two large surveys have evaluated the effects of acupuncture on people with MS. At the Rocky Mountain Multiple Sclerosis Center, we conducted a web-based survey on acupuncture on our CAM website, www.ms-cam.org. The preliminary results have been reported (6) and may be viewed at the website. Among more than 1,000 respondents, about 20 percent had used acupuncture since they were diagnosed with MS. The symptoms that were reported to be improved most frequently were pain and anxiety about two-thirds reported improvement with these symptoms. Other...

Enzyme Therapy

Enzymes are a type of protein used by the body to perform chemical reactions. Enzymes break down food in the digestive tract and carry out essential chemical functions in the rest of the body. It is claimed that treatment with enzymes is beneficial for many diseases, including multiple sclerosis (MS).

Exercise

Exercise is not always classified as a form of complementary and alternative medicine (CAM). Instead, it may be viewed as conventional medicine or entirely out of the realm of medicine, as a type of self-care or simply a component of one's lifestyle. Regardless of its formal classification, it is important to consider exercise because it is not always fully discussed during a conventional medical office visit, and it has significant health implications for people with multiple sclerosis (MS).

Treatment Method

A variety of homeopathic remedies has been suggested for multiple sclerosis (MS). The treatment regimen depends on the individual and the specific symptoms. Homeopathic remedies sometimes recommended for MS include Argentum nitricum, Aurum muriaticum, and Plumbum metallicum.

Journal Articles

Homeopathy in multiple sclerosis. Complement Ther Nurs Midwifery 2003 9 5-9. HH-yperbaric oxygen treatment is a form of oxygen therapy. It is claimed to be an effective treatment for a large number of diseases, including multiple sclerosis (MS). Unfortunately, many of the claims about this therapy are not supported by research evidence.

Editors

Benveniste has received numerous honors and awards, including NIH Training Grant Fellowships (1982-1983, 1984-1985) a postdoctoral fellowship award from the National Multiple Sclerosis Society (1986-1987) Plenary Lecturer, Fourth International Congress of Neuroimmunology (1994) Plenary Lecturer, UCLA Neurobiology of Disease Conference (1995) Member and Plenary Lecturer, Sixth International Congress on TNF and Related Cytokines (1996) Distinguished Scientist Lecturer, University of Arkansas (1998) Keynote Speaker, Great Lakes Glia Meeting (1999) Chair, FASEB Summer Conference, Neural-Immune Interactions (2000, 2002) Symposium Speaker, Oklahoma Center for Neuroscience (2003) and Executive Chair, NIH Workshop on Glial Inflammation (2003). Dr. Benveniste has served on numerous review and advisory boards. These include Member, NIH Special Section for AIDS and Related Research Review Group (1998-1991) Member, American Cancer Society Advisory Committee for Cell Biology (1992-1995)...

Toxins

Over the years, it has been proposed that many toxins may cause multiple sclerosis (MS) or worsen its symptoms. Recent reports have associated MS with aspartame use and mercury from dental amalgam, both of which are discussed elsewhere in this book. It also has been claimed that MS is provoked by cosmetics or by chemicals in the environment in the form of pollution, aerosol sprays, low levels of formaldehyde, and fumes from solvents. In food, it has been claimed that additives and low levels of residual fertilizers and pesticides may be important. On the basis of concerns about toxic causes for MS and other diseases, an entire field known as clinical ecology has emerged.

Pprf

Occlusion of posterior inferior cerebellar artery (PICA) or vertebral artery. Less common causes tumor, metastases, hemorrhage due to vascular malformations, multiple sclerosis, vertebral artery dissection (after chiropractic maneuvers), trauma, gunshot wounds, cocaine intoxication. Supratentorial Vascular lesions (single or multiple infarcts, hemor-Bilateral rhage), trauma, tumor, multiple sclerosis, encephali Brain stem, Vascular lesions, multiple sclerosis, tumor, trauma, Cerebral infarct, hemorrhage, or tumor (cortex, thalamus, white matter, internal capsule), brain stem, spinal cord syrinx, trauma, multiple sclerosis (brain stem, spinal cord)

Supplements and MS

Supplements are one of the most popular forms of CAM used by people with MS. The largest and most detailed survey of dietary supplement use among people with MS was conducted at the Rocky Mountain Multiple Sclerosis Center. Of the respondents to this survey, more than 90 percent had used dietary supplements since being diagnosed with MS, and more than 80 percent were using some type of dietary supplement at the time of the survey. The full results of the survey are available at www.ms-cam.org, the CAM website of the Rocky Mountain Multiple Sclerosis Center.

Suggested Reading

Lassmann, I. McDonald, B. Matthews, H. Wekerle McAlpine's multiple sclerosis. Churchill Livingstone, Edinburgh, London, Melbourne, New York, 1998. Polman, C. H., A. J. Thompson, T. J. Murray, W. I. McDonald Multiple sclerosis the guide to treatment and management, 5th edition. Demos Medical Publishing, New York, 2001.

Hypnosis

Hypnosis for pain and neuromuscular rehabilitation with multiple sclerosis case summary, literature review, and analysis of outcomes. Int J Clin Exp Hypn 1996 44 208-231. 2. Sutcher H. Hypnosis as adjunctive therapy for multiple sclerosis a progress report. Am J Clin Hypn 1997 39 283-290. 3. Sutherland G, Andersen MB, Morris T. Relaxation and health-related quality of life in multiple sclerosis the example of autogenic training. J Behav Med 2005 28 249-256.

Marijuana

Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study) multicentre randomised placebo-controlled trial. Lancet 2003 362 1517-1526. 2. Zajicek J, Sanders HP, Wright DE, et al. Cannabinoids in multiple sclerosis (CAMS) study safety and efficacy data for 12 months follow up. J Neurol Neurosurg Psych 2005 76 1664-1669. 3. Wade DT, Makela P, Robson P, et al. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis a double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 2004 10 434-441.

Massage

Hernandez-Reif M, Field T, Field T, et al. Multiple sclerosis patients benefit from massage therapy. J Bodywork Movement Ther 1998 2 168-174. 2. Brouwer B, de Andrade VS. The effects of slow stroking on spasticity in patients with multiple sclerosis a pilot study. Physiother Theory Pract 1995 11 13-21. 4. Forsythe E. Multiple Sclerosis Exploring Sickness and Health. London Faber and Faber, 1988 129.

C8 L3 L4 L5 S1

RT + PosT + IT, mainly proximal, disabling. Associated with lesions of nigro-striatal and cerebello-thalamic pathways (multiple sclerosis, infarct) Symptomatic (medullary lesion due to encephalitis, multiple sclerosis, brain stem infarct) or essential clicking noise in ear Cause. Infarct. Less commonly caused by hemorrhage, tumor (germinoma, teratoma, pineocytoma, pineoblas-toma, astrocytoma, tentorial edge meningioma, lymphoma), or multiple sclerosis. Cause. Infarct. Less commonly caused by hemorrhage, tumor (germinoma, teratoma, pineocytoma, pineoblas-toma, astrocytoma, tentorial edge meningioma, lymphoma), or multiple sclerosis. Cause. Tumor of third ventricle, infarct, arteriovenous malformation, multiple sclerosis, large aneurysm ol posterior fossa, trauma, shunt malfunction, metabolic diseases (Wilson disease, Niemann-Pick disease), infectious diseases (Whipple disease, AIDS)

Neurodegenerative Diseases

Neurodegenerative diseases (see 6.08 Neurodegeneration) include AD Parkinson's disease amyotrophic lateral sclerosis (ALS) demyelinating diseases, e.g., multiple sclerosis neuropathies, e.g., diabetic, HIV, and chemotoxin-induced Down's syndrome (DS) prion diseases, e.g., Creutzfeldt-Jakob disease tauopathies, e.g., Pick's disease, frontal temporal dementia with Parkinsonism (FTDP) trinucleotide repeat or polyglutamine (polyQ) diseases, e.g., Huntington's disease (HD) spinocerebellar ataxias (SCA) dentatorubral-pallidolysian atrophy (DRPLA) Friedreich's ataxia multiple systems atrophy (MSA) stroke and traumatic brain injury.

Autoimmuneneuromuscular disorders

A number of autoimmune neuroinflammatory disorders (see 6.09 Neuromuscular Autoimmune Disorders) affect either the central or peripheral nervous system. Many of these disorders are exceptionally rare such as Moersch-Woltman syndrome (stiff-man), Lambert-Eaton myasthenic syndrome, and myasthenia gravis (MG). While uncommon, these disorders tend to be highly debilitating as they directly alter neuromuscular transmission. The most common of these disorders is MG which affects an estimated 60 000 people in the USA. The primary pathology underlying MG appears to be the production of autoantibodies directed against the alpha subunit of the neuromuscular nicotinic acetylcholine receptor. Through direct interference and complement-mediated lysis of the postsynaptic muscle membrane, the autoantibodies cause disruption in the motor endplate that leads to a weakness in skeletal muscle throughout the body. The autoimmune disorder systemic lupus erythematosus (SLE) and the neuroinflammatory...

With Subcortical Infarcts And Leukoencephalopathy

CADASIL differs from other causes of diffuse subcortical ischemia, such as Binswanger's disease, by the frequent presence of migraine with or without aura, and individuals with CADASIL are not usually hypertensive. Occasionally, diagnostic confusion may occur with patients with multiple sclerosis, especially the primary progressive type, with the appearance of multiple white matter lesions.

Physiologic Abnormalities

Other than the anatomic and functional causes of constipation described above, a host of other, less common medical problems may present with constipation. Systemic illness such as diabetes mellitus, multiple sclerosis, hypothy-roidism, hypopituitarism, and porphyria may cause or exacerbate constipation. Neurologic disorders, including brain and spinal cord neoplasms, central nervous system trauma, and Parkinson's disease, are known to be associated with constipation, significantly altering the quality of life.

Background Information

Delayed-type hypersensitivity (DTH) is an in vivo T cell-dependent immune response manifested as an inflammatory reaction that reaches peak intensity 24 to 48 hr after antigenic challenge. The DTH reaction occurs at the site of antigen deposition the skin serves as the usual site for eliciting DTH in experimental systems. Typical sites of challenge are the footpad or the pinna. Histologically, DTH reactions are characterized by an intense mononuclear induration, with limited polymorphonuclear cell involvement (Sell, 1987). DTH reactions can also occur within an organ (e.g., the brain) initiating a pathology characteristic of the tissue-specific autoimmune diseases such as multiple sclerosis or experimental autoimmune encephalomyelitis (Zamvil and Steinman, 1990).

Clusterin in the Central Nervous System Historical Overview

Clusterin was originally described as a major glycoprotein synthesized in the male reproductive systems of the ram and rat.1,2 Since then it has been identified in a wide range of biological fluids and tissues in many species.1,3-9 Identification of rat clusterin messenger ribonucleic acid (mRNA) to TRPM-2 (testosterone repressed prostatic message 2),10-12 a transcript found to be prevalent in vivo in involuting tissues whether induced in experimental models or naturally during development of the embryo, raised the question of a possible involvement of clusterin in programmed cell death.13,14 Reports by several independent groups of researchers on the upregulation of the clusterin gene in brains of hamsters infected with the scrapie agent15 and of humans afflicted with Alzheimer's disease (AD),16 epilepsy,17 or gliomas,17 as well as in the degenerating human retina18 gave support to the apoptosis hypothesis and generated strong interest in the role of clusterin in the central nervous...

Injury and Autoimmunity

Since autoantibodies are detectable in healthy subjects it is not possible to say whether or not their increased detection in CNS degenerative and inflammatory disease is a result of a new primary response or the stimulation of preexisting B-cell clones by the macrophage transfer of antigen from the brain. In a chronic inflammatory disease with a suspected autoimmune aetiology such as multiple sclerosis there has been a failure to identify a primary pathogenic autoantigen, but many

Antibodies Induced By Cytokine Therapy

IFN-P-neutralizing Ab were first demonstrated in high-risk malignant melanoma patients receiving combination therapies of recombinant IFN-P and IFN-Y (141). Although no Ab to IFN-y were found, 56 developed IFN-P-neutralizing Ab notably in patients receiving IFN-P subcutaneously. In 1993, IFN-P was shown to reduce the exacerbation frequency and decrease lesion formation visualized by magnetic resonance (MR) scans in patients with multiple sclerosis (MS) (142). On this basis, prolonged therapy with two recombinant IFN-P products has been approved for the treatment of MS a glycosylated form with the predicted natural amino acid sequence (IFN-P 1a) and a nonglycosylated form with a Met-1 deletion and a Cys-17 to Ser mutation (IFNP1b) (143).

Clinical Trial Issues

Further, scales used to measure disease severity or progression are imperfect. One needs a standardized scale that can be used to provide a quantitative measure of a patient's clinical status and course or stage of progression. Scales currently in use have limitations - the Kurtzke Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite score used in MS, for example.

Unmet Medical Needs

Concerns have been raised in regard to current screening paradigms used in AED discovery, e.g., the NINDS in vivo panel, that are viewed as generating AEDs of similar efficacy (and limitations) to those already in use.29,43 In the 10 years encompassing the 1990 Decade of the Brain, eight new AEDs were introduced, none of which appears to have had any impact on the treatment of intractable epileptic patients.43 This same period also saw a doubling of the finding for epilepsy research from 40 million to 80 million and, in 1999, a major White House initiative, 'Curing Epilepsy - Focus on the Future,' focused on translational research initiatives to use the evolving knowledge of basic brain function at the genomic and proteomic levels to develop new models that would lead to new treatments for epilepsy, new AEDs as well as possible cures and prevention of the disorder(s). Like many of the debatably successful outcomes from the Decade of the Brain,44 the transition of research findings to...

Specific immune defenses

Interferons (IFN) are glycoproteins that, among other products, are released from virus-infected cells. In neighboring cells, interferon stimulates the production of antiviral proteins. These inhibit the synthesis of viral proteins by (preferential) destruction of viral DNA or by suppressing its translation. Interferons are not directed against a specific virus, but have a broad spectrum of antiviral action that is, however, species-specific. Thus, interferon for use in humans must be obtained from cells of human origin, such as leukocytes (IFN-a), fibroblasts (IFN-P), or lymphocytes (IFN-y). Interferons are also used to treat certain malignancies and autoimmune disorders (e.g., IFN-a for chronic hepatitis C and hairy cell leukemia IFN-p for severe herpes virus infections and multiple sclerosis).

In Search and Discovery of Potential New Therapeutic Indications

The search for additional indications for modafinil naturally focused on diseases associated with wake deficits and somnolence. The effects of the drug in an animal model of sleep-disordered breathing suggested that modafinil might be effective in reducing sleepiness associated with sleep apnea,50 and this was subsequently demonstrated in the clinic.51-53 Other disorders where somnolence or sedation was concomitant with the disease, e.g., Parkinson's disease,54-56 myotonic dystrophy,57-60 fibromyalgia,61 amyotrophic lateral sclerosis,62 multiple sclerosis,63 cerebral lymphoma,64 or resulting from the side-effects of other medications such as antidepressants,65 antipsychotics,66 dopaminergic D2 agonists,67,68 opioids,69 or valproic acid,70 have also proven to be amenable to treatment with modafinil. Likewise modafinil has been applied with equal success to treating the fatigue coexisting with other serious diseases, including multiple sclerosis,71,72 pain,73 and acquired...

Teitelbaum R Arnon and M Sela Weizmann Institute of Science Rehovot Israel 2007 Elsevier Ltd All Rights Reserved

8.14.3.3.4 Study of primary progressive multiple sclerosis 178 8.14.4.2 Immunological Effects of Glatiramer Acetate in Multiple Sclerosis Patients 181 8.14.4.2.2 T-cell response to glatiramer acetate in naive multiple sclerosis patients 181 8.14.4.2.3 T-cell response to glatiramer acetate in treated multiple sclerosis patients 181

Experimental Autoimmune Encephalomyelitis in the Mouse

Experimental autoimmune encephalomyelitis (EAE) is a CD4+ T cell-mediated autoimmune disease. The disease is characterized by perivascular CD4+ T cell and mononuclear cell inflammation and subsequent primary demyelination of axonal tracks in the central nervous system, leading to progressive hind-limb paralysis. EAE provides a powerful model for the study of the pathogenesis and immune regulation of CD4+ TH1-mediated tissue damage and is generally considered to be a relevant model for the human immunemediated demyelinating disease multiple sclerosis. In the SJL (H-2s) mouse, the disease is characterized by a relapsing-remitting course of paralysis, which allows assessment of the efficacy of various immunoregulatory strategies in a progressive autoimmune disease setting. In other mouse strains, such as PL J (H-2u) and B10.PL (H-2u), the disease is normally acute and self-limiting, and is not characterized by clinical relapses.

Experimental Autoimmune Encephalomyelitis in the

Studies of experimental autoimmune encephalomyelitis (EAE) in rats have provided important insight into mechanisms responsible for autoimmune tissue damage and the regulation of immune responses to self antigens. Rats of the inbred Lewis (LEW) and Dark Agouti (DA) strains are highly susceptible to EAE induced with guinea pig myelin basic protein (MBP) emulsified in a modified complete Freund's adjuvant (CFA). DA rats are also highly susceptible to EAE induced with proteolipid protein (PLP). EAE in rats is an acute paralytic disease mediated by CD4+ T cells. The earliest clinical signs begin 10 to 12 days after immunization, progressing from loss of tail tonicity to hind limb paralysis. Most rats recover by 18 to 20 days post immunization. A similar clinical picture is seen after adoptive transfer of activated T cells from MBP CFA-immunized donors, with the exception that disease onset occurs 4 to 5 days post transfer. LEW rats have been used in these studies because the acute onset...

Central Nervous System

A variety of colorectal dysfunction can be attributed to lesions of the central nervous system. Those disorders that are seen most commonly in clinical practice will be discussed, namely cere-brovascular accidents, spinal cord injury, multiple sclerosis, Parkinson's disease, and spina bifida. The incidence and prevalence of multiple sclerosis in the United States are estimated to be 3.2 per 100,000 persons and 58.3 per 100,000 persons, respectively.50 The prevalence of gastrointestinal complaints in individuals afflicted with multiple sclerosis is high and is associated with neurogenic dysfunction of other organ systems.51 Bowel symptoms are common at least 52 of patients in one series had constipation, fecal incontinence, or both,52 while other studies have shown that the prevalence of constipation varies from 2 to 20 .53 As in individuals with spinal cord injury, neurogenic bowel dysfunction secondary to multiple sclerosis is a source of considerable psychosocial impairment.54...

Specificity to Alzheimers Disease

Upregulation of clusterin and abnormal staining of lesions for apoE is not limited to AD. Brain levels of clusterin seem to be elevated in many conditions involving injury or chronic inflammation of the brain. Elevated levels of the mRNA for clusterin are seen in the hippocampus in Pick's disease as well as in AD.4 Abnormal staining for clusterin has been seen in dystrophic neurites and some NFTs in the Parkinson's dementia complex of Guam (Fig. 7.1). It has also been seen in humans in ischemic Purkinje cells which showed the shrunken and pyknotic appearance characteristic of irreversible damage.45 Intense staining for clusterin has been seen in hypertrophic astrocytes in cases of multiple sclerosis, stroke and AIDS encephalitis. In these cases, however, the distribution of clusterin did not appear to correlate with that of the MAC,46 a correlation which does appear to occur in AD.9

Diseases that affect neural function

Numerous diseases of the nervous system can result in a loss of neuromuscular function. However, these can be roughly divided into those that lead to neuronal death, those that result in the loss of the myelin sheath around the neuron preventing the conduction of action potentials, and those that affect the generation or release of neurotransmitters. Of the three categories, for the application of motor prostheses only those diseases that cause neuronal death can be treated. More specifically, only those diseases that do not affect the nerve going to the muscle have benefited from the use of these systems. Current motor prosthesis technology is dependent upon the artificial generation of action potentials in the nerve going to the muscle to cause muscle contraction. Anything that affects action potential conduction in the nerve and the subsequent excitation of the muscle via the neuromuscular junction will prevent effective use of the motor prosthesis. Therefore, the applications of...

Clinical and Medical Uses of Chronometry

Cognitive effects of normal aging, mild cognitive impairment, senile dementia, traumatic brain and closed head injuries, mortality, under-nutrition and malnutrition in children, eating disorders, parasitic infections, neurological effects of HIV and AIDS, drug effects and addictions, multiple sclerosis, sleep disorders, diabetes, attention deficit and hyperactivity disorder (ADHD), stroke, vascular dementia, degenerative brain diseases associated with aging (Huntington, Alzheimer, Parkinson), epilepsy, chronic fatigue syndrome, hypoxia, post-traumatic stress disorder (PTSD), psychiatric disorders (anxiety, schizophrenia, depression, bipolar), yoga and meditation, chemical, pharmaceutical, and nutriceutical (e.g., Gingko biloba) agents.

The Frontal Lobes and Aging

I also mentioned earlier that with aging there is a loss of subcortical white matter. Patients who have diseases that injure their white matter, such as multiple sclerosis or multiple small strokes of the white matter, frequently show evidence of frontal lobe dysfunction and do poorly on tests such as the Wisconsin Card Sorting Test because they get stuck in set.

Early Preclinical Work Leading to the Development of Gabapentin

Gabapentin was conceived as part of a drug discovery program to treat neurological diseases, including epilepsy, spasticity, multiple sclerosis, and other central nervous system (CNS) disorders. This program began in the early 1970s at the German company, Goedecke, A.G., in Freiburg, Germany, which was a part of Warner-Lambert (now incorporated into Pfizer). The history of this project included chemical attempts to inhibit g-amino-butyric acid (GABA) degradation in brain with compounds that inhibited the catalytic pyridoxylphosphate of GABA-transaminase. It had already been known for some time that GABA was a key inhibitory neurotransmitter, and that experimental chemical impairment of GABA systems could cause seizures in experimental animals. The GABA transaminase project at Goedecke had progressed a compound to phase I clinical trials, but these were halted because of safety concerns. The chemical matter developed within the GABA transaminase project had no direct relationship to...

Clusterin Expression and Localization in the Brain

Clusterin mRNA and protein levels increase in a variety of human neurologic disorders, including Alzheimer's disease (AD),7-9,16,17 multiple sclerosis,18 acquired immune deficiency syndrome (AIDS),18 Pick's disease,9 epilepsy19 and gliomas19 (see chapter 7 for complete review). Clusterin expression is also increased in a variety of experimentally-induced brain injury rodent models representing ischemia,20,21 synaptic repair,22,23 epilepsy,8,24,25 or hormonal alterations26,27 (see chapter 3 for complete review). Human CSF clusterin is increased in patients with evidence for de-myelination, but at normal levels in patients with neurodegenerative and meningeal disease.28,29

Adjunctive Therapies For Neurodegenerative Disorders

Glatiramer acetate (GA, Copaxone, copolymer-1) is an FDA-approved immunomodulatory drug for the treatment of multiple sclerosis (MS). GA immunization induces Th2 regulatory T lymphocytes secreting anti-inflammatory cytokines in mice and humans. These T cells migrate to the brain and provide bystander suppression against neuroinflammation. GA was shown to be an effective immunomodulatory treatment for neuroprotection in animal models of experimental autoimmune encephalomyelitis, optic nerve crush, PD, and AD (Kipnis et al., 2000 Benner et al., 2004 Weber et al., 2004 Frenkel et al., 2005 Wolinsky, 2006). In addition, clinical trials are ongoing in the use of GA in the treatment of ALS (Gordon et al., 2006). A newly completed study in our own lab tested the effects of GA immunization on neuropath-ological outcomes in rodent models of HIVE. GA administration resulted in significant neuroprotection accompanied by increased levels of IL-10 and BDNF (Gorantla et al., submitted)....

The secondary narcolepsycataplexy

Association of cataplexy with EDS with another disorder of the brain was first reported in the early 1900. These associations includes tumors, localized most frequently to the diencephalon or to the brain stem, other diencephalic lesions (e.g. , large arterio-venous malformation, or lesions secondary to ischemic events), multiple sclerosis with plaques in the diencephalon, head injury, encephalitis, etc. In young children, Niemann-Pick disease type C, characterized by hepatosplenomegaly, progressive ataxia, dystonia, dementia and vertical supranuclear opthalmoplegia, is often associated with cataplexy early in life, as pointed out by Challamel et al. 63 . Cat-aplexy was noted much earlier in these children with Niemann-Pick, than in a group of prepubertal children 35 with a mean age of onset of 6years 63-66 . The other cause of very early onset of secondary cataplexy is craniopharyngioma. This tumor is one of the most common brain tumors in children and account for 9 of all pediatric...

Blood Lymphocytes And Demyelination

The classic example of demyelination of the CNS is multiple sclerosis (MS), in which a chronic inflammatory lesion is characterised by a sharply demarcated plaque containing preserved axons denuded of myelin. Demyelination also occurs in infectious diseases such as progressive multifocal leucoencephalopathy and acute disseminated leucoencephalitis, but it is the disseminated focal form of MS that will be addressed in this review article. Multiple sclerosis is often considered to be an immune-mediated disease because cellular and soluble components of the immune system are found within lesional areas, abnormal distributions of lymphocyte subsets, cytokines, and immunoglobu-lins occur in the blood and cerebrospinal fluid, and because it has pathological and clinical similarities to experimental allergic encephalomyelitis (see below). Com-promisation of the blood-brain barrier leads to an increased permeability that produces extensive local tissue oedema and passage of blood mononuclear...

Patients with Concomitant Disease Neurologic Diseases

Subsequent analysis revealed the largest group of conditions associated with constipation was neurologic and psychiatric disorders. A number of dramatic associations between constipation and neuropsychiatric and spinal diagnoses were observed, including herpes zoster (OR 5.1), depression (OR 6.5), multiple sclerosis (OR 3.9), Parkinson's disease (OR 3.2), vertebral column fracture (OR 10.1), and sprains and strains of the sacroiliac (OR 7.7) region.24 These associations suggest a potential link between central nervous system (CNS) function and constipation. Of particular interest was the strong association between herpes zoster and constipation. The zoster virus resides in the posterior root ganglia and can damage the ganglionic or spinal neurons. This association hints at a possible viral contribution to the onset of constipation among some patients with idiopathic constipation. The prevalence of constipation among populations of patients with specific neurologic disease has also...

Conclusions

The availability of orally active inhibitors of ICE will no doubt advance anticy-tokine-based therapies for a variety of inflammatory and autoimmune diseases. Initially, ICE inhibition was thought to be highly specific, because it blocked the secretion of IL-1p. Inhibition of IL-1P also appeared to be safe in terms of host defense perturbations. With the discovery that processing of proIL-18 is also accomplished by ICE, there was no longer the advantage of specificity. In terms of host defense effects of ICE inhibitors, the role of IFN-y (as a product of IL-18 activity) must be considered, since a reduction in IFN-y is thought to be undesirable in terms of defense against tuberculosis and some other infectious diseases. On the other hand, inhibition of the Th1 response by ICE inhibitors (due to reduced IFN-y production) is a worthwhile strategy in many diseases. For example, graft versus host disease, organ rejection, type I diabetes, and other autoimmune diseases of the Th1 type. In...

Neuromyelitis Optica

Schumacher Criteria for the Diagnosis of Multiple Sclerosis Adapted from Schumacher FA, Beeve GW, Kibler RF, et al. Problems of experimental trials of multiple sclerosis. Ann NY Acad Sci 1965 122 552-568. Poser Criteria for the Diagnosis of Multiple Sclerosis Clinically definite multiple sclerosis (MS) (Adapted with permission from Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis guidelines for research protocols Ann Neurol 1983 13 227-231, and from John Wiley and Sons.)

Blepharoptosis

Frontalis Advancement

INTRODUCTION Blepharoptosis, or ptosis, is a drooping of the upper eyelid such that the eyelid margin rests lower with respect to the superior corneal limbus. There are numerous causes for ptosis and these can be classified according to mechanistic etiologies. Aponeurotic ptosis is caused by defects in the levator aponeurosis, either redundancy or frank disinsertion. This can be seen from trauma or surgery, or as an involutional phenomenon which is the most common form of adult acquired ptosis. Myogenic ptosis results from myopathic or myogenic diseases affecting the levator muscle. It most commonly occurs as a congenital developmental defect, but can be associated with chronic progressive external ophthalmoplegia, myotonic dystrophy, oculopharyngeal dystrophy, myasthenia gravis, trauma, or toxins. In neurogenic ptosis there is an interruption of nervous innervation to the levator muscle. Etiologies include vascular lesions, ischemia, multiple sclerosis, toxins, infections, tumors,...

Overview

Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS) are the best known neurodegenerative diseases, but also included in the category of neurodegeneration are demyelinating diseases (e.g., multiple sclerosis, Charcot-Marie-Tooth, neuromyelitis optica), neuropathies (e.g., diabetic, human immunodeficiency virus (HIV), chemotoxic), Down's syndrome, prion diseases (e.g., CreutzfeldtJakob disease), tauopathies (e.g., Pick's disease, frontal temporal dementia with parkinsonism (FTDP)), additional trinucleotide repeat or polyglutamine (polyQ) diseases (e.g., spinocerebellar ataxias, dentatorubral-pallidolysian atrophy, Freidreich's ataxia), multiple systems atrophy, stroke, and traumatic brain injury. The current chapter focuses on AD, PD, HD, and ALS multiple sclerosis and stroke are covered elsewhere in this volume (see 6.09 Neuromuscular Autoimmune 6.10 Stroke Traumatic Brain and Spinal Cord Injuries).

Types of Biomarkers

The concept of biological markers of disease is both old and new. Historically, markers for disease have been used to diagnose and monitor disease risk, progression, improvement, and severity.67 Examples are clinical chemistry for many disease states, histological markers such as Papanicolaou smears for cervical cancer, magnetic resonance imaging (MRI) for multiple sclerosis, as well as serum markers associated with cancer states, i.e., prostate-specific antigen (PSA), carcinoembryonic antigen (CEA), and cancer antigen-125 (CA-125).29,65,68-73 Markers that can be assessed from blood and or urine samples are very reliable in determining the clinical status of the disease. In most references, the definitions of biomarkers and its categories are often used interchangeably, but for clarity, the functional categories of biomarkers will be used in this discussion (Figure 3).64,65,67,74 Biomarkers can be categorized as disease biomarkers

Rectal Prolapse

Markedly Redundant Colon

They have two or fewer bowel movements per week. Malaise, bloating, nausea, and abdominal cramping are frequent complaints. Symptoms are typically unresponsive to bulk laxatives and stool softeners. There is often a strong association with gynecologic complaints such as irregular menstrual cycles, ovarian cysts, and galactorrhea. Many patients have delayed gastric emptying, biliary dyskinesia, and delays in small bowel transit, suggesting the presence of a panenteric motility disorder.18-20 A diagnosis of colonic inertia is made only after excluding systemic neurologic processes such as diabetes mellitus or multiple sclerosis, or a pelvic floor abnormality as a cause.

Abt724

The worldwide prevalence of ED has been estimated at over 152 million males with projections for 2025 being in excess of 320 million. In older males, ED may have a physical cause, such as disease, injury, drug side effects, injury to nerves, arteries, smooth muscles, and fibrous tissues, or impaired blood flow in the penis. Other common causes of organic ED include the metabolic syndrome, diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologically related causes.9 The incidence of ED increases with age with approximately 5 of 40-year-old males and 15-25 of 65-year-old males experiencing aspects of ED. Surgery, including radical prostatectomy and bladder cancer surgery, can injure nerves and arteries near the penis, causing ED. Antihypertensives, antihistamines, antidepressants, and hypnotics can produce ED as a side effect. Psychological factors including stress, anxiety, guilt, depression, low self-esteem, and fear of sexual...

Treatment Strategies

Psychostimulants such as methylphenidate, pem-oline, and dextroamphetamine have shown great promise in the treatment of fatigued patients with cancer and multiple sclerosis (Krupp et al., 1989a Weinshenker et al., 1992). These drugs have also been used safely and successfully in HIV patients with fatigue (Holmes et al., 1989 Wagner and Rabkin, 2000 Breitbart et al., 2001). Breitbart and colleagues (2001) conducted the first randomized, double-blind, placebo-controlled trial of two psychostimulants for the treatment of fatigue in ambulatory patients with HIV disease. They found that both methylphenidate hydrochloride (Ritalin) and pemoline (Cylert) were equally effective and significantly superior to placebo in decreasing fatigue severity with minimal side effects. Fifteen patients (41 ) of 144 ambulatory HIV patients taking methylphenidate and 12 patients (36 ) taking pemoline experienced clinically significant improvement, as compared to 6 patients (15 ) taking placebo. The...

Condition

Skull fracture.(depressed) Head trauma Intracranial hemorrhage Acute stroke Multiple sclerosis Brain tmnor metastases Pneumonia Chest trauma Chest mass Hem opt ysis Pulmonary embolism Aortic aneurysm dissection Aortic tear (trauma) Carotid stenosis Esophageal obstruction Esophageal tear Bowel perforation Hematemesis Peptic nicer disease Abdominal trauma

Info

MBP has previously been shown to induce experimental allergic encephalomyelitis (EAE), a well-examined animal model for multiple sclerosis (MS), in several rodent strains (Martin et al., 1992). This protein is used as an example to show potential epitopes that might be recognized by human CD4+ T cells in the context of MS-associated HLA-DR alleles, most notably HLA-DRB1*1501, HLA-DRB5*0101, and an allele found in MS patients with different ethnic backgrounds (i.e., DRB1*0401 Martin et al., 1991 Vogt et al., 1994 Muraro et al., 1997 Smith et al., 1998). Figure A1I.1 depicts the peptide-binding motifs for DRB1*1501, DRB5*0101 (Vogt et al., 1994), and DRB1*0401 (Hammer et al., 1995), and demonstrates where anchor motifs can be found in an immunodominant area of the protein (amino acids 83 to 99). Thus, the presence of DR-binding motifs for three disease-associated DR alleles forms a prerequisite for their high-affinity binding to the respective DR al-leles, and explains why this area of...

Text Mining

This means that when a field in a record or document labeled as disease (through the zoning process) contains the entity MS, the latter can be identified and disambiguated to multiple sclerosis. Thus zoning allows us to correctly identify an entity in a given context and to extract even more information according to the metaknowledge related to the data source (such as attributes). This metaknowledge is part of a data structure, the Metastore, which we explain below.

Men10755

Pixantrone (17) is an azaanthraquinone, evolved from mitoxantrone in a search for drugs with lower cardiotoxicity.96 It was selected from a series of analogs on the basis of high cytotoxic activity, significant in vivo antitumor efficacy (especially against lymphomas and leukemias) over a wide dose range, and a lack of delayed cardiotoxicity compared with other anthracenediones.97 It is a DNA intercalating agent and topo II inhibitor,98 but it is not clear if this is its only mechanism of action, since its DNA damaging effects do not correlate with cytotoxicity.99 While pixantrone is not as potent as mitoxantrone it is also less cardiotoxic at equieffective doses, less myelosuppressive, and shows better in vivo activity in leukemia and lymphoma models.96 The drug appears to be most useful in the treatment of non-Hodgkin's lymphoma100 a recent multicenter Phase II trial used a dose of 85 mg m _ 2 in a 3-weekly protocol, gave 9 33 remissions with a median relapse time of 17 + months,...

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