functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
to follow the use of HBOT in these ‚nontraditional‛
conditions. This chapter is not designed
to outline the established uses of hyperbaric
medicine, which are well published and
documented. Rather, the purpose is to review the
current literature regarding the use of HBOT for
the treatment of three of our most challenging
conditions: multiple sclerosis, autism, and traumatic
brain injury.
Multiple Sclerosis
Clinical Vignette
RW, a 56 year old married white female, began
to have atypical headache approximately 25 years
ago. She presented repeatedly to her primary care
physician over the course of 10 years with
complaint of head and neurological changes. Her
husband, an internal medicine specialist, sought
expert opinion from a local university with a
specialty head pain clinic. She was given a
diagnosis of ‚complex migraine stroke‛ after having
normal brain studies and neurological examinations.
She continuedto experience atypical migraine
headache with subsequent temporary loss of vision
and motor function. After approximately 10 years,
she was diagnosed by MRI with relapsing-remitting
multiple sclerosis, based on typical periventricular
white matter changes. Further studies such as
spinal fluid analysis for oligoclonal banding was
notpursued. She has been treated with a variety
of interferon medications and is currently taking
interferon-beta (Rebif), muscle relaxors and an
antidepressant. Neuropathic pain is managed with
a Fentanyl patch every 72 hours. Physical exam
findings include obesity and right lower extremity
weakness, particularly quadraceps weakness,
necessitating the use of a cane for assistance with
ambulation. The patient’s husband admits to
concerns with her ability to reason and emotional
lability. Neuropsychological assessment has not
been performed (Beck Depression Inventory,
Modified Boston Naming Test, MMSE,
Constructional Praxis, and Word List Memory as
examples.)
Review of the Literature and Discussion
141
Multiple sclerosis (MS), a disease of unknown
etiology, is the ‚most common autoimmune
inflammatory demyelinating disease of the central
nervous system.‛ (5) It is characterized by
inflammation of the central nervous system leading
to nerve demyelination. Ultimately, axon
degeneration leads to clinical manifestations, such
as weakness of extremities, numbness, and
psychological changes. (6) MS is most commonly
know to affect women of childbearing age of
Northern European lineage, with Northern Ireland
having the highest per capital population of MS
patients.(7)
The differential diagnosis of MS is fairly broad and
includes genetic and congenital CNS
diseases, inflammatory diseases such as
polyarteritis nodosa, systemic lupus erythematosus
(SLE), Behçet’s disease, Sjögren's disease,
retroviral illness, and syphilis. Many of these
conditions can cause similar MRI changes and
manifest with peculiar neurological symptoms.(8)
The current standard for diagnosis is the
McDonald criteria. The principle of diagnosis rests
with establishing a pattern of clinical findings and
MRI changes across both space (different areas
of the CNS) and time (symptoms and lesions are
evolving). Clinical findings suggestive of the
disease include age of onset between 15 and 50
years, a relapsing remitting pattern of neurological
change, optic nerve involvement, and fatigue.
The diagnosis does not rely upon laboratory
evidence of the disease.(9) The pathophysiology
of MS revolves around the concept of CNS
vascular inflammation causing disruption of the
blood brain barrier leading to an autoimmune
assault involving the myelin sheaths. This repetitive
demyelination ultimately leads to permanent
neurologic damage and subsequent clinical
symptoms.(10)
The cornerstone treatment of MS involves immune
modifying interferon beta-1b (Betaseron) and
beta-1a (Avalox), and glatiramer acetate
(Copaxone). Other treatments focus on relieving
symptoms and improving quality of life through the
use ofphysical therapy, occupational therapy, anti-
2012