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Neuro (week 8) Demyelinating Dz


myelin speeds conduction along axons to 20-100m/sec from .5-2.5m/sec
demyelination-->slow or stop impulse

SX
limbs weak, paresthesias, numbness
optic neuritis may occur in teens, 20's, resolves in 2-6 weeks, blind mostly in one eye, then no prob for months to years, but look out
diplopia
RLS, vertigo
bladdery dysfx
increased subjective feeling of fatigue dt compensation for neuro deficit

CONDITIONS
MS
transverse myelitis
optic neuritis
PML, progressive multiple leuko...
leukodrystrophies
Guillain Barre
chronin inflam demyslin polyneuropathy
Charcot-Marie-Tooth dz

Richard Prior

MRI FOR PATHOL HALLMARKS
perivasc inflam and demyelin
plaques in CNS, mc: optic, brainstem, cerebellum, cord
lesions correlate with sx
axon sparing within plaques

MS
mercola's update: http://articles.mercola.com/sites/articles/archive/2011/05/17/american-cancer-society-and-dermatologists-dead-wrong-about-the-sun.aspx
dz of young person
mc disabling in young adult
mc demyelinating
chronic
progressive
unpredicatble course
variety of s/sx, oft mistaken fo psych
current theory of etio favors AI
spike incidence 20-35, 29 the average
white spot on MRI--demyelinate-->tingle, numb, feels like ground is moving like a dock on water
pts walk near wall to hold on, head spinning-->nausea-->can't eat
constipation, incr urinary sx, nocturia, frequency
opp sides of body affected, vertigo
remissions, seasonal and geographical patterns--only occurs above/below 45th parallel
occurs in scandinavia except along coast
pineal gland role paper in 1997, dysfx-->def of ser and melatonin
pineal sensit to envir stim incl light, electric fields, temp, humiditiy, cosmic and nuclear radiation-->circadian rhythm affected

ETIO
low vit D: sunshine, early life matters most, lots of MS here in Oregon
mercury toxicity
salt
AI component

p4 watch video on brain degen on mercury, time lapse
http://commons.ucalgary.ca/showcasetv/mercury

Al Huggins
dentist who took out mercury fillings

Dr T agrees with my theory that old (over 15 years) fillings don't contain much mercury
and he was a dentist (40 years ago) before he became a naturopath
used bare hands to squeeze mercury amalgams through cheesecloth to prep materials
fillings: if they're 3 years or less old then take them out immediately
over 15 years old: take them out when they are breaking down but not before
3-15 years old: discussion with patient
don't drill them out because they vaporize, cause higher exposure
goal with removal: split them and chip them out, using high volume dam and suction, extra care and training
he does removal 3 years into tx
research has been done using chewing gum
ask dentist: do you have any mercury in this office? if they say yes find another dentist, they don't get it

TYPES OF MS
benign 10% relapses back to baseline
relapsing remitting 40% gradually increasing sx with relapses-->secondary
secondary chronic progressive 40% goes from relapsing to progressive
primary progressive 10% never gets better, no remitting
50% of pts enter secondary phase 10 years after r/r phase

DX CRITERIA
2 attacks with lab evidence but no clinical = probable ms
skipped the rest, get it from notes
hx and PE most imp
neuro exam
blood and urine
MRI does not correlate with severity of debility, shows plaques but mb inflam is real indicator
lumbar px
oligoclonal bands present in 85% of confirmed MS

TX
early intervention, Dr T regrets that he isn't able to intervene early---pts don't get to him in time
aggressive
immune stim interferons can delay or even prevent crippling sx of MS: avonex, rebif, betaseron, copaxone
steroids
beta interferon 1a: avonex weekly, rebif 3x/wk
copaxon is sub sntigen that mimics myslin basic protein, inhitis CNS immune rxns that cause tissu camage
subcu daily injx, reduces number of attacks and brain lesions


SYMPTOMATIC THERAPY
fatigue-->cool showers, baths, amantadine helps 40%, pemoline
spasticity: baclofen may cause mm weakness, useful in spastic dysarthria
valium at night
lots more in notes
spastic bladder: anticholinergics, baclofen
detrusor/ext sphincter dysfx

TX
vit D, sunshine, fish, omegas, antiox
low fat diet, very low sat fat, Swanck diet, avoid land mammal animal fat
decr gluten, milk
eat veg numt, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseeds, EPO
ala, vit E, se, lecitthin, B12 IM, TPIN
bile salts, lipase
seacure 6/day
tryptophan
transdermal histamine (Jonathan Wright) Dr T tried on 5 pts with no good results, so he stopped
ice on spastic mm
homeop: nux vomica his fave, mag phos as cell salt

PROG
variable
50% chance of walking unadied 15 years after onset
longevity 25-35 years after dx
causes of death: complic of immobility, depression-->suicide

GOOD PROG
females have less relapses
complete recovery after 1st attack
long interval between 1st and 2nd
younger onset with intervention
late cerebellar involvement
low disability 2-5 yrs from onset

THE SCIENCE
diet not helpful
vit D helps
bee sting therapy didn't help

OPTIC NEURITIS
1st sx in 25% of pts
blurry in one eye
affects 75% of MS pts eventually
examine eye
usu better in 6 wks
future risk of MS
he txs anyone who's had ON as if they had MS
oral prednisone no demonstrated efficacy (Neurol J)
better results with vit D, fish oil

CURE
he's txd pts for 15-17 years who have no more issues
he thinks they don't have MS anymore

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