Albert Einstein defined insanity as "doing the same thing over and over again and expecting different results." For the last 30 years, management of acute spinal cord injuries has usually included high dosages of the steroid methylprednisolone. Perhaps the rationale for this treatment was based more on the theory of how corticosteroids were supposed to work than the reality. In a 2006 survey of spine surgeons, only 24 percent reported that they believed that methylprednisolone had any clinical value in spinal cord injury, yet 90.5 percent indicated they continued to administer this treatment protocol.1
The greatest obstacle to healing damage in the central nervous system (brain and spinal cord) is overcoming autoimmune and other factors, which inhibit nerve regeneration. If we were to apply methods that were successful in accomplishing this, the prospects for functional recovery from spinal cord injuries, multiple sclerosis and Parkinson's disease should take a giant step forward.
Spinal cord injuries might result in partial to total paralysis and loss of sensation below the site of the trauma. Approximately 250,000 Americans have spinal cord injuries with approximately 11,000 new cases annually. Of those, 52 percent are paraplegic and 47 percent quadriplegic. Care is mostly supportive, palliative – and very expensive. Average lifetime costs for the care of paraplegics are $428,000 and $1.35 million for quadriplegics.2
Light on Nerves
Whereas peripheral nerve injury might be relatively easy to heal, regeneration of neurons in the brain and spinal cord is more difficult, commonly hindered by autoimmune issues, secondary injury and lack of growth factors. A growing body of science suggests that energy-based treatments, particularly laser phototherapy, may improve recovery and quality of life in spinal cord injury and other CNS conditions. Low intensity lasers have been documented to protect nerves and preserve their function, increase axonal regrowth and myelination, diminish scar tissue at the site of the lesion and reduce degeneration of the associated motor neurons in the spinal cord.
Byrnes et al. studied the effects of transcutaneous laser light in spinal cord injury in rats. Six percent of light penetrated to the spinal cord, and treatment significantly increased the number of axons and the distance of nerve re-growth, suppressing immune cell activation and restoring some portions of function to their baseline levels.3
Laser phototherapy has proven to be useful to enhance the proliferation of stem cells and other cultured cells and is being studied as a key method to stimulate regeneration not only of peripheral and CNS neurons, but of other cells and tissues.4,5,6
Multiple Sclerosis
When it comes to multiple sclerosis, recent advancements have proved to be promising. "Our results from the use of laser therapy on multiple sclerosis cases shows that laser biostimulation is a successful and effective method by which to treat patients," said Dr. Cezary Peszynski-Drews, director of the Laser Diagnostics and Therapy Center of the Technical University of Lodz, Poland. Dr. Peszynski-Drews, also noted, "While it does not prevent multiple sclerosis, it makes patients significantly stronger, even in the most advanced stages of the disease. After treatment, patients are able to move around on their own, walk short distances, and make their own breakfast. They are not totally dependent on someone else to help them and this in itself is a personal success."7
Multiple sclerosis (MS) is an inflammatory disease in which myelin, a protective lining around axons in the brain and spinal cord, is attacked by the immune system. Over time the injured nerves degenerate and form the multiple sclerotic plaques, which give the condition its name. Signs, symptoms and the clinical course of MS are highly variable, depending upon the location of the nerves affected. Yet those with MS frequently suffer bladder or bowel dysfunction, pain, loss of sensation, spasticity and loss of vision as a result of degraded nerve transmission.
Low intensity laser phototherapy has anti-inflammatory, immune modulating and tissue regenerative properties. It has also been reported to improve quality of life for MS patients. In a study at the University of Heidelberg, 42 subjects with MS received a series of 10 treatments with transcutaneous laser irradiation of the blood over four superficial veins within two weeks and a second series of three sessions over three weeks. Subjects reported a 16 percent improvement in physical quality of life and a 67 percent improvement in psychological quality of life. It is noteworthy that the improvements in both physical and psychological quality of life were long-lasting, still well above baseline 12 months following the last treatment.8
A Multiple Sclerosis Case Study
*Tim was a 61-year-old male diagnosed with relapsing, remitting MS, 12 years earlier. His chief complaints were pain (neck, wrists, knees, ankles), numbness, tremors, weakness, poor coordination, fatigue, depression, weak appetite, memory loss, vertigo and sleep. It should be noted that he had eaten only a single daily meal - or just snacked as opportunity allowed when his employer referred him to our clinic and offered to pay for a series of treatments. He was also taking 15 drugs: Avonex, Synthroid, Zestril, Prozac, Wellbutrin, Ritalin, Gabapentin, Thorazine, Klonopin, Flexeril, Sinequan, Acyclovir, Darvocet, lodine and Phenergan.9
*Tim was treated with laser therapy, transcutaneous laser blood irradiation, LED therapy and acupuncture during five regular weekly office visits and also received 10 sessions of bio-electromagnetic therapy, near daily at the outset. All pain scores improved progressively. Eight months after completing the treatment series paid for by his employer, *Tim was asked to describe the results. "I am stronger, and pain is less," he said. "The effects have lasted. The biggest difference is that I can feel things and hold onto them better with my hands. My energy and mood are better."
Standard practice in treating MS has been limited in large part to pharmaceutical drugs thought to slow its progression (beta interferons), treat symptoms or reduce inflammation during exacerbations (steroids). While these methods may be helpful, to my knowledge they have not reversed the condition. Energy-based treatments, including laser and LED phototherapy and bio-electromagnetic therapy, have been shown to stimulate nerve regeneration and function, even in CNS injury. They might reduce the demyelination, inflammation and neuropathies, which are associated with multiple sclerosis. Implementing these energy-based therapies and studying their effects has the potential to raise the bar in healthcare and may significantly improve quality of life in MS.
Parkinson's Disease
Signs and symptoms of Parkinson's disease are associated with damage to the substantia nigra, cells at the base of the brain which produce dopamine. When Shaw et al. administered near infrared light to dopaminergic cells from the substantia nigra, they found that it protected them from the effects of MPTP, a substance known to induce Parkinson-like symptoms. "In summary, our results indicate that NIr (near infrared) light treatment offers neuroprotection against MPTP toxicity for dopaminergic cells in the SNc (substantia nigra), but not in the ZI-Hyp (hypothalamus)."10
Breakdown and impaired function of mitochondria, resulting in insufficient ATP production has been implicated in the pathogenesis of Parkinson's disease (PD). Trimmer et al. proposed this was the cause of reduced axonal transport occurring in PD and also observed, "...that a single, brief treatment with near-infrared light can restore axonal transport to control levels. These results are the first demonstration that LLLT (low level laser therapy) can increase axonal transport in model human dopaminergic neuronal cells and they suggest that LLLT could be developed as a novel treatment to improve neuronal function in patients with PD."11
A Parkinson's Disease - Case Study
*Sylvia was a 74-year-old female who had been diagnosed with Parkinson's disease four years earlier. She was also diabetic and on blood pressure medication. Her complaints were muscle weakness, poor coordination, low energy, back pain, depression and stress. She was treated with near daily bio-electromagnetic therapy for 35 days and weekly acupuncture and laser therapy.
*Sylvia reported significant improvements in energy, muscular control and mood. Blood pressure and sugars, color and demeanor also improved. Her gait became steady and rapid. Time to go from a sitting in the lobby to supine position in the treatment room was reduced from 40 to 21 seconds.
References
Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine. Apr 20 2006;31(9):E250-3.
Byrnes KR, Waynant RW, Ilev IK, Wu X, Barna L, Smith K, Heckert R, Gerst H, Anders JJ. Light promotes regeneration and functional recovery and alters the immune response after spinal cord injury. Lasers Surg Med. 2005 Mar;36(3):171-85.
Alghamdi KM, Kumar A, Moussa NA Low-level laser therapy: a useful technique for enhancing the proliferation of various cultured cells. Lasers Med Sci. 2011 Jan 28. [Epub ahead of print]
Tuby H. Maltz L. Oron U, Implantation of low-level laser irradiated mesenchymal stem cells into the infarcted rat heart is associated with reduction in infarct size and enhanced angiogenesis.Photomed Laser Surg 2009 Apr;27(2):227-33
Eduardo Fde P, Bueno DF, de Freitas PM, Marques MM, Passos-Bueno MR, Eduardo Cde P, Zatz M. Stem cell proliferation under low intensity laser irradiation: a preliminary study. Lasers Surg Med. 2008 Aug;40(6):433-8.
Physical and psychological benefits to quality of life reported following transcutaneous blood irradiation in 42 patients with MS courtesy of Dr. Detlef Schikora, University of Paderborn, Faculty of Science, Germany.
Polypharmacy is "the act or practice of prescribing too many medications." Websters Revised Unabridged Dictionary.
Shaw VE, Spana S, Ashkan K, Benabid AL, Stone J, Baker GE, Mitrofanis J. Neuroprotection of midbrain dopaminergic cells in MPTP-treated mice after near-infrared light treatment. J Comp Neurol. 2010 Jan 1;518(1):25-40
Trimmer PA, Schwartz KM, Borland MK, De Taboada L, Streeter J, Oron U Reduced axonal transport in Parkinson's disease cybrid neurites is restored by light therapy. Mol Neurodegener. 2009 Jun 17;4:26.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
