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 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.”