Featured Case

TITLE OF CASE

Integrative successful treatment of Multiple Sclerosis

Dr Shibu Varghese

ABSTRACT 

A 46-year-old female, diagnosed with Multiple sclerosis presented with difficulty in walking, writing, fine movements and involuntary nodding of the head since 2 years. The patient was normal until 14 years back. In 2008, she developed a sudden blurring of vision for which she took the standard of care. She was diagnosed with Retrobulbar neuritis. Etiological workup was done, and she was discharged. Based on MRI findings, she was provisionally diagnosed as Multiple Sclerosis. Her vision became normal  but she developed fatigue that was managed with home remedies. In 2009, the condition relapsed. The biomedical diagnosis was confirmed as Relapsing-remitting Multiple sclerosis with Brain MRI. By 2014, the patient developed difficulty in writing, she noticed that her handwriting started changing. By 2019, the symptoms worsened, and she developed nodding of head, inability to walk and repeated episodes of tremors. In spite of taking conventional medicines, the outcome was not satisfactory.  In 2021, she consulted Dr Shibu Varghese, for ayurvedic supportive management. The ayurvedic diagnosis was Vatavyadhi. The line of treatment was to correct dhatvagni, adopt dhatugata and sannipata jvara cikitsa, tikta rasa followed by madhura rasa prayoga and rasayana cikitsa. The outcomes were assessed based on EDS Scale, Ambulation Index, and Neurologic physical examination. After 2 weeks of treatment, patient could walk without support. The frequency of head nodding reduced, handwriting of the patient has improved. The EDS scale that was 7 before treatment became 2 after 2 weeks of ayurvedic treatment. Ambulation index was recorded 2 pre-treatment became 0 after treatment. The patient is continuing the medicines and advised to come for regular follow ups.

KEYWORDS

Multiple Sclerosis, Vata vyadhi, Ayurveda, Case report, Integrative

INTRODUCTION

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibres and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerve fibres.

Signs and symptoms of MS vary widely between patients and depend on the location and severity of nerve fibre damage in the central nervous system. Some people with severe MS may lose the ability to walk independently or ambulate at all. Other individuals may experience long periods of remission without any new symptoms depending on the type of MS they have. The common symptoms are Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, Tingling, Electric-shock sensations, Lack of coordination, Unsteady gait or inability to walk, Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement, Prolonged double vision, Blurry vision, Vertigo and mood disturbances.

Disease course: Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years. Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses, known as primary-progressive MS.

Diagnosis: There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis. Blood tests, MRI and spinal tap will help ruling out other major pathologies.

PATIENT INFORMATION

A 46-year-old female, diagnosed with Multiple sclerosis presented with difficulty in walking, writing, fine movements and nodding of the head since 2 years.

Medical History: The patient was normal until 14 years back. In 2008, she developed a sudden blurring of vision for which she took the standard of care. She was diagnosed with Retrobulbar neuritis. Etiological workup was done, and she was discharged. Based on MRI findings, she was provisionally diagnosed as Multiple Sclerosis. Her vision was recovered but developed fatigue that she managed with home remedies. In 2009, the condition relapsed. The biomedical diagnosis was confirmed as Relapsing-remitting Multiple sclerosis with Brain MRI. By 2014, the patient developed difficulty in writing, she noticed that her handwriting started changing. By 2019, the symptoms worsened, and she developed nodding of head, an inability to walk and repeated episodes of tremors. In spite of taking conventional medicines, the outcome was not satisfactory.  In 2021, she consulted Dr Shibu Varghese for trying supportive ayurvedic treatments. The ayurvedic diagnosis was Vatavyadhi. The line of treatment was to correct dhatvagni, adopt dhatugata and sannipata jvara cikitsa,  tikta rasa followed by madhura rasa prayoga and rasayana cikitsa

CLINICAL FINDINGS/PHYSICAL EXAMINATION

General examination: PR - 68 bpm, HR- 68 bpm, BP-110/70 mm/Hg

Table 1. Nervous system examination at baseline added below

 

Reflex	Right side	Left side
Biceps	3	3
Triceps	3	3
Knee	4	4
Ankle	3	3
Supinator	3	3
Babinski reflex	Positive	Positive

Cortical

Tactile localisation: Intact

Graphesthesia: Not able to identify some letters like M, S, N etc

Cerebellar

Tandem Walking- Slightly possible

Heel walking- Not possible

Toe walking - Not possible

Sensory: Superficial, touch, temperature and pain intact

Deep: Crude touch, vibration, joint sense and position – present

EDSS/EDS Expanded Disability Status Scale:

At baseline documented as 7 (More severe disability impairing one's daily activity and requiring assistance )

Ambulation Index (A1)

At baseline – Left hand 2, Right hand 3.

Shrugging of shoulders- Possible

Turning the neck- With a slight tremor

TIMELINE

Image 1. Timeline of events attached below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter: The patient was a known case of Relapsing remitting multiple sclerosis.

Image 2. Diagnosis proof document dated 2009 added below

Image 3. RRMS graph drawn by the treating physician added below

Ayurvedic Assessment was done based on the clinical evaluation by the ayurvedic physician.

Differential Diagnosis- This does not apply as the patient came with a confirmed diagnosis.

Prognosis- The condition is often mild at the early stages and as it progresses, the symptoms worsens. The prognosis varies widely for RRMS. Some patients rarely have flare ups and go years without having new clinical problems. Others have frequent attacks and require extensive medication treatment. In this case report, in spite of taking conventional medicine, the disease was progressing and symptoms were worsening. With ayurvedic treatments, the patient was able to regain fine movements in 2 weeks.

THERAPEUTIC INTERVENTION

See the tab ‘Treatment details’

FOLLOW-UP AND OUTCOMES

Clinician-based assessment;

Before treatment - Patient walked with support and after treatment- patient could walk without any support. 

Frequency of head-nodding reduced. 

Video 1. Patient is able to read verses without nodding of head

Video 2. Patient is able to walk without support

Handwriting of the patient has improved.

The EDS scale was 7 before treatment became 2 after 2 weeks of ayurvedic treatment.

Ambulation index: Left hand was 2 before treatment became 0 and right hand was 3 before treatment became 1 after 2 weeks of treatment.

RRMS graph shows the disease is now stable without any activity.

Table 2. Coordination tests documented before and after ayurvedic treatment added below

	On the day of admission	After Udwarthanam	After fulll treatment
Finger to nose test	Not possible	Possible with   effort	Possible
Finger test	Not possible	Possible with effort	Possible
Knee-heel test	Possible	Possible with effort	Possible
Dysdiadochokinesia	Not possible	Possible with effort	Possible

Table 3. Fine movements documented before and after treatment.

Fine movement	On the day of   admission	After 1 week	After     Udwarthanam
Grain picking	Unable	30 grains	250 grains

 

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well.

Method of assessment- By monitoring the patient.

Adverse and unanticipated events; None reported.

DISCUSSION ;

The treatments given were: dhatugata jwara cikitsa, sannipata jwara cikitsa, tikta rasa prayoga followed by madhura rasa prayoga and rasayana cikitsa.

PATIENT’S PERSPECTIVE

Not available.

LEARNING POINTS/TAKE-HOME MESSAGES

This case report demonstrates the successful ayurvedic management of multiple sclerosis, in a A 46-year-old female patient, who was suffering from relapsing remitting Multiple sclerosis,with the symptoms progressing and worsening over time.

INFORMED CONSENT

Written consent was obtained from the patient to publish the case report.

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. Mayo Clinic. Multiple Sclerosis. https://www.yahoo.com

_________________________________________________________________________________________________________________

Image 1. Timeline of events

 

Image 2. Diagnosis proof document dated 2009 added below

 

 

Image 3. RRMS graph drawn by the treating physician added below

 

 

 

 

 

 

Image 4. Handwriting of the patient before treatment added below