Arrested Progression of Symptoms of a Patient Diagnosed with Multiple System Atrophy for a Period Over 6 Months
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1
Innova Brain Rehabilitation Center, United States
Objective:
Elucidate possible treatment options to clinicians managing patients diagnosed with multiple system atrophy (MSA).
Overview and Clinical Features:
MSA is a group of disorders that affect the central and autonomic nervous system. The condition is progressive, and is thought to involve the oligodendrocytes which are damaged by excessive accumulation of the alpha-synuclein protein. Problems with the autonomic system characterize MSA such as orthostatic intolerance, sexual dysfunction, constipation, and others. There are 2 types of MSA. The cerebellar or C-type is characterized by tremor, balance problems, dysphagia and dysarthria. The P or Parkinson type is differentiated by more of the classic Parkinson's disease symptoms such as bradykinesia. With the P-type traditional treatments for Parkinson's may help, but it is short lived as the disease progresses much faster than Parkinson's disease.
Patient a 67 y.o. Caucasian male was diagnosed with MSA at an internationally known and respected teaching hospital 7 months prior to consultation at our facility. Significant medical history: played high school football, loss of consciousness age 25 from blow to the back of the head with a large steel pipe, orthostatic intolerance age 34 (“blacked out” twice on standing), testicular cancer with trucal radiation, and surgery age 38, foot drop with T-6 herniation age 40, “optical” migraines began at age 41, right and left hip replacement age 52, lost sense of smell age 54 (relates it to use of OTC Zycam), diminished libido age 58, vertigo age 60, writing and reading difficulty (micrographia and dyslexia) age 61, increasing issue with sporadic orthostatic hypotension, loss of temperature appreciation and depressed pain sensation in left lower quadrant and extremity leading to T-6 discectomy, heightened emotionality, right hand tremor, increased snoring treated with mouth piece age 62, arthritis left knee, head on motor vehicle collision resulting in fractured sternum and 2 ribs, worsening amplitude and frequency of tremor now involving all four extremities at age 66.
Examination findings that supported the previous diagnosis and gave insight into altered brain functionality were as followed: Increased systolic blood pressure supine vs seated, right V:A ratio 2:1, right exodeviation, right convergence insufficiency, diminished bilateral plantar responses, slower and fatiguing rapid alternating movements and finger tap on the right, tremor associated with activity of left triceps, gait with double tasking caused “freezing”, VOG testing demonstrated failure of gaze holding especially in elevation and depression, saccadic vertical pursuits, slight downward and no upward OKN, computerized dynamic posturography revealed moderately compromised balance on a perturbed surface with eyes closed and head turned right and extended and a maximal posterior center of pressure of 1.97 inches and a maximal A-P sway of 3.00 inches.
Intervention and Outcome:
Treatment consisted of 4 days of intensive (3x/day) brain rehabilitation that included passive (transitioning to active) complex movements of proximal joints, repetitive, peripheral, somato-sensory stimulation in the form of symmetrical bi-phasic electrical stimulation, whole body off-vertical axis rotational therapy, spinal and extra-spinal manipulation followed by a brain-based home exercise program that was employed for a period of at least 6 months. During the intensive 4 day program there were distinctive positive changes in the bio-markers. Remote follow up with the patient 6 months after his intensive treatment, revealed that his condition has been stable with no further progression of his symptoms.
Conclusion:
There may be non-invasive, and non-pharmaceutical methods that could be effective in arresting the symptomatic progression of MSA. More research is indicated to explore the potential effects of these types of therapeutic interventions.
References
Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71(9):670–676. doi:10.1212/01.wnl.0000324625.00404.15
Pearaully, T, Multiple system atrophy. Semin Neurol. 2014 Apr;34(2):174-81. doi: 10.1055/s-0034-1381737. Epub 2014 Jun 25.
Keywords:
Multiple System Atrophy,
orthostatic hypotension,
Micrographia,
alpha-Synuclein,
off-axis whole body rotational therapy
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Duffy
JL and
Patterson
FE
(2019). Arrested Progression of Symptoms of a Patient Diagnosed with Multiple System Atrophy for a Period Over 6 Months.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00040
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Received:
02 Apr 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Mx. James L Duffy, Innova Brain Rehabilitation Center, Marietta, Georgia, 30062, United States, jduffy@innovabrain.com