Back Clinic Research Studies. Dr. Alex Jimenez has compiled study and research projects that are pertinent to the science and art of chiropractic medicine. The subsets can be classified as following: Case Study, Case Series, Cross-Sectional, Cohort, Case-Control, and Randomized Control Trials. Each subset of study profiles has its merits and scientific significance.
It is our intention to bring clarity to present-day research models. We will discuss and present significant clinical interpretations that may serve outpatients well. Great care in selecting appropriate and well-documented models has been enforced in our blog. We gladly will listen and heed comments on the discussed subject matters presented. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
Shane Scott was involved in an automobile accident when he heard about Dr. Alex Jimenez, chiropractor, from a friend. After experiencing headache, neck and low back pain, several days after the incident, Shane Scott’s quality of life, especially as a new father, was tremendously affected. Thankfully, treatment with Dr. Alex Jimenez has helped Shane Scott return to his regular daily activities. Shane Scott highly recommends Dr. Alex Jimenez as the non-surgical choice for neck pain treatment, encouraging many others to visit him.
Chiropractic Neck Pain Treatment
Neck pain (or cervicalgia) is a frequent problem, where two-thirds of the populace will experience neck pain some time in their lives. Neck pain can be brought on by numerous other spinal issues. Neck pain may arise due to muscle tightness in either the neck and upper spine, or pinching of the nerves emanating from the cervical vertebrae. Joint disturbance in the neck generates pain, as does joint disruption in the top back. The head is supported by the lower neck and upper spine, and it is these places that commonly cause neck pain.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Louie Martinez, business owner, first chose to see Dr. Alex Jimenez, chiropractor, after he suffered several injuries which resulted in lower back pain, among other symptoms. Louie Martinez trusts in Dr. Alex Jimenez’s treatment because it gives him the thorough relief he needs immediately. Before seeing Dr. Alex Jimenez for lower back pain treatment, Louie Martinez experienced pain and limited mobility. However, after initial treatment, his symptoms were tremendously improved. Louie Martinez highly recommends Dr. Alex Jimenez as the non-surgical choice for lower bak pain treatment, among others.
Lower Back Pain Chiropractic Treatment
A lumbar strain is a stretch injury to the ligaments, tendons, and/or muscles of the lower spine. The extending episode ends up in microscopic tears of varying degrees in those cells. A lumbar strain is considered one of the most frequent causes of lower back pain. The injury can occur due to overuse, improper use, or injury. Soft-tissue injury is commonly categorized as “severe” if it has been present for weeks. If the strain lasts longer than three months, it is known as “chronic.” Lumbar strain most often happens in individuals in their 40’s, however, it can occur at any age. The health issue is characterized by localized discomfort in the lower back region.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Did you know that inflammation and low back pain can by caused by a low pH balance? Inflammation is believed to be caused by a variety of factors, including injury and/or an underlying condition, however, recent research studies have found a connection between inflammation, chronic back pain and pH balance. The lower your pH balance is, the more acidic your body is. When the human body is acidic, a condition referred to as acidosis, it can cause inflammation and other symptoms throughout the body, even in the lower back. Whether your pH balance or another health issue is causing your low back pain, it’s important to understand how acidity and low pH levels can affect the structure and function of the human body.
Metabolic acidosis is a condition used to describe when there is too much acid in your body fluids. When there is too much acid in your body, your pH balance reading will be low. In other words, your body will be considered acidic. When the human body is acidic, it neutralizes the acid by leaching calcium, magnesium, potassium and sodium from the bones. Over time, the excess acidity of the body can begin to gradually eat away at the bones, causing the progressive degeneration of the bones and eventually even leading to fractures. While a fracture may seem like a severe cause for back pain, the degeneration of the vertebrae of the spine can also cause disc degeneration disease, or DDD, leading to back pain and low back pain. The purpose of the article below is to demonstrate as well as discuss the relationship between low pH balance in intervertebral discs and low back pain.
The Relationship Between Low PH in Intervertebral Discs and Low Back Pain: a Systematic Review
Abstract
Introduction: To systematically review the relationship between low pH in intervertebral discs and low back pain.
Material and methods: Electronic database (PubMed, ISI Web of Science, Cochrane Library, CINAHL, AMED, and China National Knowledge Infrastructure) searches and hand searching of conference proceedings were conducted. Two authors independently evaluated the methodological quality and abstracted relevant data according to standard criteria. Then the experimental methods and samples employed in the finally retrieved articles were assessed.
Results: We first retrieved 136 articles regarding pain and pH, and only 16 of them were mainly about low back pain and pH. Finally, 7 articles met our expectation to focus on the pathogenesis of low back pain caused by pH. In these 7 studies the authors held three opinions to explain the pathogenesis of low back pain in relation to low pH. First, low pH caused by lactate stimulates the muscle and increases the muscle tension, which causes low back pain. Second, low pH stimulates the nerve roots and produces the feeling of pain. Third, low pH changes the matrix metabolism, leading to neuronal death and low back pain.
Conclusions: In this systematic review we propose a new hypothesis that low back pain may be caused by low pH based on the previous literature. Further experimental studies are necessary to verify our hypothesis. This hypothesis will promote our understanding of the pathogenesis of low back pain and the development of novel diagnostic and therapeutic approaches for low back pain.
Keywords:low back pain, pH, acidity, intervertebral disc, systematic review
Introduction
Low back pain is one of the most frequent causes of morbidity and disability. Low back pain affects up to 50% to 80% of the population in developed countries and its recurrence rate amounts to 85%, resulting in an economic loss of approximately 50 to 100 billion dollars per year in the US [1, 2].
Currently, effective treatment of low back pain is severely hampered due to the fact that its pathogenesis remains elusive [3, 4]. In recent years, several hypotheses have been proposed to explain the pathogenesis of low back pain and most of them focus on the dysfunction of the spinal column and its components, such as injury and clinical instability [5�7], spinal column degeneration [8], inferior facet-tip impingement on the lamina [9], and Schmorl’s nodes [10] and facet joint injury [11]. Other hypotheses focus on subfailure injury of the spinal muscles and ligaments and propose that spinal ligaments, disc annulus, facet capsules and thoracolumbar fascia may cause chronic back pain due to muscle control dysfunction [12�16]. In addition, the pain adaptation and pain-spasm-pain hypotheses have been proposed [17�19]. However, these hypotheses are largely speculative and need further experimental investigations.
The intervertebral disc (IVD) is composed of the nucleus pulposus (NP), the annulus fibrosus (AF), and the endplates (EP). The corpora vertebrae lie above and below the discs. The healthy disc is avascular, and its nutrition depends on diffusion via the AF and EP [20, 21]. The discs mainly produce ATP via anaerobic glycolysis; consequently lactate is produced and the pH is lower than other tissues. Low back pain is known to be related to intervertebral disc degeneration, and the pH would decrease in degenerated intervertebral discs [22, 23]. Therefore, low pH in the discs may be related to low back pain. Indeed, Hambly and Mooney [24] reported a close relationship between low back pain and low intradiscal pH in rabbits, while Krapf et al. [25] found that low pH could cause muscle spasm which was related to low back pain.
Based on the previous literature we propose a new hypothesis that low pH may cause low back pain. In this systematic review, we have collected and analysed the relevant literature regarding the relationship between low pH and low back pain to address the following questions: (1) What role does low pH play in low back pain? (2) Is the relationship obvious between low pH and low back pain? And (3), why are low pH and low back pain so relevant?
Material and Methods
Electronic databases (PubMed, ISI Web of Science, Cochrane Library, CINAHL, AMED, and China National Knowledge Infrastructure), which were last updated on 26 Nov. 2011, were searched without limit by two independent investigators. The search used terms and Boolean operators as follows: (low back pain OR lower back pain OR low back ache OR low backaches OR lumbago OR recurrent low back pain OR postural low back pain or mechanical low back pain) AND (low pH OR lactate OR lactate OR hydrogen ion concentration). Reference lists of all the selected articles were hand-searched for any additional trials. Conference abstracts of key pain and orthopaedic journals were hand-searched to identify unpublished data. If necessary, we contacted the authors to get additional information.
In total 136 articles were initially identified by literature search, and 113 articles were excluded after checking the titles and abstracts, which did not reach our expectation. Next we reviewed the full texts of the remaining articles and excluded the following articles: (1) articles not in English; (2) reviews, systematic reviews or letters; (3) pain in other tissues; (4) not related to pH, acidity or protons. As a result, 16 articles were retrieved and the references of these 16 articles were checked to ensure that other pertinent publications would not be missed. Finally, seven articles met our expectation to focus on the pathogenesis of low back pain caused by pH (Figure 1). The literature search was performed by two of the authors (CZL and HL) independently, and any disagreement was resolved by discussion.
We scrutinized the seven articles with the focus on �the mechanisms by which pH causes low back pain�, and then assessed the experimental methods and samples employed in the seven articles.
Results
Seven articles met our expectation [26�32]. Then we evaluated the level of evidence for each article, according to the standard listed in Table I [33]. Five of them were level II, and two were level III. The characteristics of the seven studies are listed in Table II.
Nerve Roots
Three studies involving 32 patients [26, 27, 29] suggested that low pH would stimulate the nerve roots and cause low back pain.
Diamant et al. analysed the correlation between lactate level and pH in discs of patients with lumbar rhizopathy and found that low pH was caused by the increased lactate level due to the enhanced anaerobic glycolysis within the NP, which counteracts the decreased nutritional diffusion. The reaction of nerve roots in cases with low pH is related to increased production and leakage of acid metabolism. Sensitive structures such as the nerve roots could be irritated by the leakage of acid metabolites and it was shown that pain will arise in tissues with low pH [26, 34].
Keshari et al. used HR-MAS NMR spectroscopy to analyse snap frozen samples taken from 9 patients who underwent discectomy for painful disc degeneration [27, 35, 36]. They found that proteoglycan, collagen, and lactate may serve as metabolism markers of discogenic back pain. Therefore, they speculated that low pH was caused by increased lactate and increased lactate stimulated nerve fibres in granulation tissue associated with disc healing, which was correlated with discogenic pain [27, 35, 36].
Baumann et al. examined the responses of cultured adult human dorsal root ganglion (hDRG) neurons to low pH [29]. They found that low pH evoked, sustained depolarizations were due to more than one mechanism, and the inhibition of resting membrane conductance contributes to the responses to low pH in some hDRG neurons, which was related to low back pain [29].
Muscle Tension and Swelling of Connective Tissue
A previous study suggested that low pH would increase muscle tension, which could cause low back pain [30]. The authors examined 20 patients with chronic palpable tension of the erector muscles of the spine, and found that the pH decreased because of the enhanced anaerobic glycolysis in NP. The low pH was caused by the accumulation of lactate. Lactate would stimulate the multifidus muscle and increase the muscle tension. Simultaneously, myogelosis is induced, leading to low back pain [30]. Vormann et al. [31] showed that the simple and safe addition of an alkaline multimineral preparate was able to reduce the pain symptoms in these patients with chronic low back pain. These results suggest that a disturbed acid-base balance may contribute to the symptoms of low back pain.
Metabolism
Bartels et al. measured the oxygen and lactate concentrations in 11 patients with back pain and 13 patients with scoliosis, and found that in each case, the oxygen and lactate concentrations were the highest in the interior of the disc and fell toward the outer annulus [28]. Therefore, they speculated that the microcirculation through the endplate and the rate of cellular metabolism would influence the oxygen and lactate concentrations in the disc. For instance, the oxygen concentration would fall as cellular demand increases; consequently the lactate concentration would increase and the pH would decrease. It was observed that in some discs the concentration of oxygen was less than 40 mm Hg and that of lactate was more than 5 mmol/l, which would lead to cell death.
Another study also indicated that decreased pH, decreased PO2 and increased PCO2 may be related to the mechanisms of pain production in patients with back pain [32]. These abnormalities can be identified by magnetic resonance imaging. Further investigation is needed to determine whether therapeutic manipulation of these variables can be effective in relieving axial spinal pain.
Low pH would lead to a change in the matrix metabolism, which could strongly influence the cell activity and even cause cell death. It is well known that acid-sensing ion channels (ASICs) on the cell surface could be stimulated by protons. After cells die, the protons would increase and activate ASICs, which in turn mediate ischaemic neuronal death [37], and eventually cause low back pain [28, 38�40].
Dr. Alex Jimenez’s Insight
When an individual’s bodily fluids contain too much acid, or they’re too acidic,�a common concern known as acidosis, it can lead to a variety of health issues if not properly addressed. Your lungs and kidneys can generally compensate for slight pH imbalances, however, problems with any of these organs or even an improper nutrition consisting of processed foods high in sugar, can result in excess acid accumulating in the human body. Other risk factors which can contribute to an increased chance of developing acidosis include: a high-fat diet that’s low in carbohydrates, kidney failure, obesity, dehydration, aspirin or methanol poisoning, and diabetes. Furthermore, as mentioned in the article, acidosis has also been associated as a cause of inflammation which may lead to chronic back pain and low back pain. Therefore, maintaining pH balance is believed to be able to help treat low back pain, alongside other alternative treatment options, such as chiropractic care.
Discussion
After careful review of the seven articles we retrieved, we obtained a systematic view with regard to the relationship between low pH and low back pain, although the authors of the individual studies had proposed three different opinions.
If low pH directly stimulates the nerve roots, the pH is very important to the healing of low back pain. Lactate would cause low pH, stimulate the nerve roots, cause depolarization at the surface of the nerves, and modulate the nociceptors to let the patients feel pain. However, in order to establish a relationship between discogenic back pain and lactate, a much larger number of patients need to be studied and the changes in proteoglycans (PG)/collagen (col), PG/lactate peak (Lac), and Lac/col ratios should be correlated with visual pain scores or other pain indexes [27, 29].
The second opinion holds that low pH would act on the muscle but not nerve roots. If the oxygen tension falls below 5 mm Hg, the muscle tension would increase, and even result in myogelosis. Muscle contraction depends solely on the chemical energy of ATP. If the oxygen tension decreased, the cells would undergo anaerobic glycolysis and produce much lactate, leading to decreased pH. However, it remains elusive what level of pH would cause pain [30].
The third opinion claims that disc energy and matrix metabolism are crucially involved in low back pain [38�40]. This provides a valuable insight into the pathogenesis of low back pain. Nevertheless, the detailed cellular and molecular mechanisms by which disc energy and matrix metabolism disruption lead to neuronal death and eventually pain development are not completely understood.
This systematic review had several limitations. First, the heterogeneity between individual studies was substantial. Second, there are only small number patients in several prospective cohort studies of selected articles. Third, there may be some selection bias because the retrieved articles were confined to limited databases.
In conclusion, in this systematic review we propose a new hypothesis that low back pain may be caused by low pH based on previous literature, in which three opinions have been proposed by the authors to explain the pathogenesis of low back pain in relation to low pH. First, low pH caused by lactate stimulates the muscle and increases the muscle tension, which would cause low back pain. Second, low pH stimulates the nerve roots and produces the feeling of pain. Third, low pH changes the matrix metabolism, leading to neuronal death and low back pain. These different opinions are not exclusive but may be complementary. Further experimental studies are necessary to verify our hypothesis that low pH causes low back pain. This hypothesis will promote our understanding of the pathogenesis of low back pain and the development of novel diagnostic and therapeutic approaches for low back pain.
Acknowledgments
This study was partly supported by a grant from the National Nature Science Foundation of China (81171756) and the Science and Technology Planning Project of Zhejiang Province (2012C13G2010083).
In conclusion,�a lower pH balance can mean that your blood is more acidic, while a higher pH balance means that your blood is closer to the levels it should be at. While these numbers may only appear to differentiate slightly, these numerical differences can be serious and may ultimately affect your overall health and wellness. In the article above, researchers proposed that low back pain may be caused by low pH levels. Furthermore, the outcome measures of the systematic review will help support the understanding of the pathogenesis of low back pain, promoting more treatment options for chronic back pain. Information referenced from the National Center for Biotechnology Information (NCBI).�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
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Difficulty making eye contact, gestures and words at the same time
Little imitation of others
No longer uses words they used to use
Uses another person�s hand as a tool
Social Interaction
Difficulty making eye contact
Lack of joyful expression
Lack of responsiveness to name
Does not try to show you things they�re interested in
Repetitive Behaviors & Restricted Interests
Unusual way of moving their hands, fingers or body
Develops rituals, such as lining up objects or repeating things
Focuses on unusual objects
Excessive interest in a particular object or activity which interferes with social interaction
Unusual sensory interests
Under or over reaction to sensory input
ASD Diagnostic Criteria (DSM-5)
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
ASD Diagnostic Criteria
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
Hyper – or Hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
ASD Diagnostic Criteria
Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
ASD Diagnostic Criteria (ICD- 10)
A. Abnormal or impaired development is evident before the age of 3 years in at least one of the following areas:
Receptive or expressive language as used in social communication;
The development of selective social attachments or of reciprocal social interaction;
Functional or symbolic play.
B. A total of at least six symptoms from (1), (2) and (3) must be present, with at least two from (1) and at least one from each of (2) and (3)
1. Qualitative impairment in social interaction are manifest in at least two of the following areas:
a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;
c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people�s emotions; or lack of modulation of behavior according to
social context; or a weak integration of social, emotional, and communicative behaviors;
d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual).
2. Qualitative abnormalities in communication as manifest in at least one of the following areas:
a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling);
b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person;
c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases;
d. lack of varied spontaneous make-believe play or (when young) social imitative play
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:
a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus;
b. Apparently compulsive adherence to specific, nonfunctional routines or rituals;
c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements;
d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they
generate).
C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders; specific development disorder of receptive language (F80.2) with secondary socio-emotional problems, reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioral disorders; schizophrenia (F20.-) of unusually early onset; and Rett�s Syndrome (F84.12).
Asperger�s Syndrome Diagnostic Criteria (ICD-10)
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
failure to develop peer relationships appropriate to developmental level.
a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest to other people).
lack of social or emotional reciprocity.
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
apparently inflexible adherence to specific, nonfunctional routines or rituals.
stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements).
persistent preoccupation with parts of objects.
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self- help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Inattention – gets off task easily
Hyperactivity – seems to move about constantly
Impulsivity – makes hasty actions that occur in the moment without first thinking about them
ADHD Risk Factors
Genetics
Cigarette smoking, alcohol use, or drug use during pregnancy
Exposure to environmental toxins during pregnancy
Exposure to environmental toxins, such as high levels of lead, at a young age
Somatic signs including sleep disturbances, enuresis or urinary frequency
*The onset of PANS may start with infectious agents other than strep. It also includes onset from environmental triggers or immune dysfunction
Pediatric Autoimmune Disorders Associated With Streptococcus
(PANDAS)
Presence of significant obsessions, compulsions and/or tics
Abrupt onset of symptoms or a relapsing-remitting course of symptom severity
Pre-pubertal onset
Association with streptococcal infection
Association with other neuropsychiatric symptoms (including any of the PANS �accompanying� symptoms)
PANS/PANDAS Tests
Swab/Strep culture
Blood tests for strep
Strep ASO
Anti-DNase B Titer
Streptozyme
Test for other infectious agents
MRI preferred but PET can be used if necessary
EEG
False Negatives
Not all children who have strep have elevated labs
Only 54% of children with strep showed a significant increase in ASO.
Only 45% showed an increase in anti�DNase B.
Only 63% showed an increase in either ASO and/or anti�DNase B.
Treatment Of PANS/PANDAS
Antibiotics
IVIG
Plasmaphoresis
Anti-Inflammatory protocols
Steroid medications
Omega-3’s
NSAIDS
Probiotics
Injury Medical Clinic: Chiropractor (Recommended)
Sources
�Attention Deficit Hyperactivity Disorder.� National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml.
Autism Navigator, www.autismnavigator.com/.
�Autism Spectrum Disorder (ASD).� Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 May 2018, www.cdc.gov/ncbddd/autism/index.html.
�Introduction to Autism.� Interactive Autism Network, iancommunity.org/introduction-autism.
Shet, Anita, et al. �Immune Response to Group A Streptococcal C5a Peptidase in Children: Implications for Vaccine Development.� The Journal of Infectious Diseases, vol. 188, no. 6, 2003, pp. 809�817., doi:10.1086/377700.
�What Is PANDAS?� PANDAS Network, www.pandasnetwork.org/understanding-pandaspans/what-is-pandas/.
Irrespective of a continuous surge in interest regarding the ketogenic diet, exactly why is it that individuals have been utilizing this dietary pendulum swing from the�nutritional worries that have been spreading across the world? Many people appear to be�obsessed with the latest diet fads and trends associated with achieving and maintaining a balanced weight and supporting overall health and wellness. Research studies have demonstrated evidence outcomes regarding the benefits of dieting.
The National Weight Control Registry has stored data about these types of ongoing research studies. More than half of subjects involved in these varieties of tests and evaluations had revealed that they were following some sort of diet or intended to become involved in programs or routines for weight loss. You often see annual reports listing the very best diets, including: the Top 5 Diets to Try in 2018, According to Experts, published by Time magazine. Moreover, the report claims that healthcare professionals have ranked the DASH Diet as the number one diet, followed by the Mediterranean Diet, Weight Watchers, the MIND diet, the TLC Diet and Volumetrics, as the top diets to try this year. The article, however, additionally discusses the ketogenic diet and ranks it as being among one of the lowest-ranked diets to try this year. No further details are given about this diet and the consensus appeared to be that it is challenging to follow.
However, the ketogenic diet is actually one of the most popular diets people generally talk about, subtly out-ranking paleolithic diet in most conversations. As a matter of fact, you may have already read or heard about the ketogenic diet from a variety of sources or perhaps you may even known a friend or a family member who has been trying it out themselves. A frequent concern about popular or fad diets, though, is that there doesn’t seem to be an exact guide on how to properly follow them, what kinds of problems they may cause, and/or even for whom these might be most appropriate. With eating habits like those described in the ketogenic diet, there are frequently risks or disadvantages, often involving nutrient deficiencies or lack of efficacy, especially if they’re truly hard to follow. But, how can this common issue regarding the proper diet be solved? Foremostly, it’s essential for individuals to weigh the advantages and disadvantages when choosing to attempt the ketogenic diet.
What is the Ketogenic Diet?
Let’s start with some history of what, where and when the ketogenic diet begain. There are various diets out there today which may have a lot in common with this well-known diet. Simply take a peek at a newstand, a bodybuilding website, or maybe the blogs of practicing healthcare professionals. First developed in 1921 by Dr. Russell Wilder of the Mayo Clinic as an alternative for children with intractable epilepsy, a classical ketogenic diet is supposed to alter the human body’s natural inclination to metabolize carbohydrates for energy. This can be achieved by adjusting an individual’s nutritional daily value to a particular macronutrient intake ratio of 4:1 fat-to-carbohydrates and protein diet. In this arrangement, fat comprises approximately 90 percent of daily calories, together with 7 percent of proteins and 3 percent of carbohydrates. Some alternatives for the ketogenic diet include a Medium Chain Triglyceride Diet consisting of 70 percent of fats, 10 percent of proteins and 20 percent of carbohydrates, or a Modified Atkins Diet with much more protein including 70 percent of fats, 25 percent of proteins, and 5 percent of carbohydrates, and a Low-Glycemic Index Treatment consisting of 45 percent of fats, 28 percent of proteins and 27 percent of carbohydrates.
The consequence of eating in this manner mimics what occurs when engaging in physical activities or exercise as well as what happens when fasting, a process referred to as ketosis. In ketosis, there is a depletion of glycogen reserves in the muscles and in the liver, which ultimately causes the liver to produce ketone bodies that can be used as fuel instead. Some healthcare professionals advise using either ketone strips or a sugar ketone meter to test the levels of ketosis in urine or blood. There is also a breath ketone analyzer available for purchase on Amazon. Don’t confuse ketosis with ketoacidosis, or the potentially deadly condition common to Type 1 diabetics when there are incredibly substantial levels of blood glucose and ketones.
Proof the Ketogenic Diet Works
It goes without saying, when a new dietary routine is useful for weight loss, nutrition experts understand they may also be used therapeutically for the treatment of many different diseases and ailments, among other health issues. The ketogenic diet has been used for decades to help with the treatment of epilepsy, and it has gained recent traction in its use for the treatment of obesity, type 2 diabetes, cardiovascular disease and neurological disorders. It has even been demonstrated to positively affect the gut microbiota.
Research studies regarding the use of a very-low carbohydrate, high fat diet for obesity, however, is in its initial stages. One research study, retrospectively in comparison to a non-carb/ketogenic-style diet, utilized a classic low-carb diet in bariatric patients, focusing on weight loss. The researchers found comparable weight-loss between both diets by 12 months post-intervention. Nonetheless, the ketogenic dieters that obtained follow-up guidance on a restricted carbohydrate routine had the best success following 24 months, indicating importance of care regarding an individual’s specific dietary habits.
One masterpiece post from 2008 clearly outlines the benefits of restricting carbohydrates to cause a unique metabolic state that favorably impacts atherogenic dyslipidemia, fatty acid partitioning and metabolic syndrome. The report clearly demonstrates that ketone bodies represent an efficient fuel for the body, about 25 percent more efficient at producing ATP than glucose or fatty acid, with curative potential towards numerous health issues. Following a carbohydrate-restrictive diet might also lead to a decrease in the release of pro-inflammatory chemicals, substances and compounds, which ultimately has positive implications for cardiovascular health.
On the reverse side, another research study found that the information on the effects of ketogenic diets on cardiovascular disease appeared to be contradictory in animal and human studies to produce an astounding recommendation. Recently presented in the 2018 American Diabetes Association seminar, a research study consisting of a 2-year randomized controlled trial, compared a high-carbohydrate diet to some very-low carbohydrate, like the ketogenic diet, with a reduced saturated fat diet in type 2 diabetic subjects. Both diets provided similar weight loss and reductions in HbA1c, whereas the very-low carbohydrate diet enabled participants to reduce their use of drugs/medications and improved their diurnal blood glucose equilibrium and blood lipids.
Missing Link in Keto Diet
One challenge that many healthcare professionals often face, however, is that sometimes, the ketogenic diet can make you feel sick. There is even a term for this: the Keto Flu. This is mostly because of a change in electrolyte conditioning together decreased insulin levels, resulting in a greater need for potassium, magnesium and sodium. If not properly managed, it can lead to nutrient deficiencies of those electrolytes, among different micronutrients, that may have consequences not completely elucidated as a result of the paucity of research on the long-term use of the ketogenic diet. Sodium is generally over-consumed in a typical diet, and a lot of high-sodium foods make their way into ketogenic diet cured meats, cheeses, and other foods that are processed. But most individuals in Western cultures today do not get enough potassium or magnesium, found mainly in fruits and vegetables, which may play a fundamental role in the pathology of chronic diseases like stroke and kidney stones.
A 2007 research study emphasized the risk factors for kidney stones after following the ketogenic diet. Approximately 6.7percent of the children who have been prescribed the ketogenic diet for intractable epilepsy were reported to have developed kidney stones. In these cases, utilizing potassium citrate significantly diminished the incidence of kidney stones and increased the expression time on the ketogenic diet. Potassium citrate solubilizes calcium, thus decreasing concentrations of free calcium readily available to crystallize. Additionally, it will also help to improve urine pH, helping to dissolve uric acid crystals. The research study concluded that “oral potassium citrate in clinical and prospective studies, using this treatment empirically was justified.”
Dr. Alex Jimenez’s Insight
The ketogenic diet, or the keto diet for short, is a low-carb, high-fat diet which has been previously described to offer many heath benefits. As a matter of fact, numerous research studies have demonstrated how this type of diet can help with weight loss as well as help improve overall health and wellness. The ketogenic diet may often be described as a “difficult to follow” diet because it involves drastically reducing carbohydrate intake to replace it with fat. However, its this reduction in carbs which allows the human body to enter a metabolic state known as ketosis. Once the human body enters ketosis, it becomes tremendously efficient in burning fat and turning it into energy, additionally turning fats into ketones in the liver, supplying energy directly to the brain. This, along with reductions in blood sugar and insulin levels, can have a variety of health benefits, making the ketogenic diet suitable for individuals with specific health issues.
Advice on the Keto Diet
If you would like to try the ketogenic diet or feel like it would benefit you in any sort of way, first make sure to check with your healthcare professional. There are a number of resources online and in texts that aren’t all peer-reviewed. Use the information with care and listen to your own body. Remember: this kind of diet requires additional understanding of biochemical processes, it may behard to follow due to its limitations and possible lack of palatability, and it has to be limited in length. Also, based on one’s genetics, the keto diet can yield quite different outcomes.
Nutrition is a fundamental part of overall health and wellness. Proper nutrition can ultimately affect the way an individual’s bodily system’s functions and without it, a variety of structures and functions can be affected. If you are seeking treatment for a specific health issue, nutrition becomes even more important. Chiropractic care focuses on the natural treatment of the spine, through the use of spinal adjustments and manual manipulations, as well as through the implementation of lifestyle modifications, to provide the human body with all the necessary components it needs to heal itself, without the use of drugs/medications and/or surgery. Many chiropractors often recommend the ketogenic diet, alongside chiropractic care, to improve well-being. Be sure to talk to your doctor of chiropractic, or DC, regarding any nutrition plan you want to follow and they can discuss the best options for your specific health issues and basic treatment needs.
That made clear, there are some smart recipes available on the marketplace to rival those which have observed from the fantastic Paleo popularity. One standout origin for the ketogenic diet is the Charlie Foundation website, which was put up to give dietary advice for caregivers of young children with uncontrolled epilepsy. Check out their site for ideas to feed your keto. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Antioxidants are scientifically referred to as compounds which restrict the oxidation process in the human body, that if left unchecked, it can create free radicals which can develop numerous chain reactions that may cause cellular damage. Fortunately, the human body can create such built-in immune mechanisms, however, when mounting reactive oxygen species, or ROS, are unable to be neutralized, envision a tiny flame which gets out of control when infused with oxygen, harm is bound to occur.
To continue expanding on the metaphor of the flame, the final product of not having the ability to neutralize the impact of ROS, or reactive oxygen species, is damage as well as inflammation, in other words, the human body is quite literally on fire. The fantastic thing is there are antioxidants which can tremendously help fight this health issue and this antioxidant is glutathione. Though found in 1889, glutathione’s antioxidant effect has become one of the most interesting topics in modern research studies.
Master of Antioxidants: Glutathione
The powerful�substance is a tripeptide that develops from cysteine, glutamic acid, and glycine. Because of its capability to protect the human body against the creation of free radicals, glutathione can ultimately help promote a healthy immune system. Based on Scientific Reports in 2015, it was determined that glutathione’s capacity to function synergistically with peroxiredin and catalase helps guard cells against hydrogen peroxide. This synergistic formula functions against reactive oxygen species, or ROS. Glutathione, peroxidredin and catalase are essential elements in the increase of cellular homeostasis, which is an essential process of healthy cells, tissues and organs altogether.
Additionally, glutathione increases overall immune system structure and function utilizing its important effect on lymphocyte functions. According to the Department of Immunochemistry, properly supplementing levels of glutathione in the human body can greatly enhance immune reactions. By way of example, two randomized placebo-controlled trials demonstrated that the therapeutic treatment of immune-compromised patients with N-acetyl-cysteine, or NAC, resulted, in both cases, in a substantial growth in most immunological processes which included an entire rejuvenation of natural killer cell activity. N-acetyl-cysteine, or NAC, uses the sulfur from glutathione and combines it with poisonous molecules, which then become water-soluble and are discharged in the human body.
Glutathione also has the capability to revitalize lipoic acid as well as to recycle Vitamin C and E, which are necessary in order to initiate certain system processes by sending electrons to neutralize free radicals. Based on a research study from PLOS ONE, glutathione affected patients with diabetes metillus, or T2DM, and mycobacterium tuberculosis. Normally, individuals with weak immune systems have a tendency to show greater exposure to M. tb, or mycobacterium tuberculosis, disease or infection. Furthermore, individuals with Type 2 diabetes metilllus, or T2DM, are two to three times more prone to TB than people without T2DM. The research study also suggested that boosting the levels of glutathione in macrophages isolated from patients with T2DM led to improved control of M.Tb disease or infection. These results demonstrate that lower levels of glutathione in patients with T2DM contributes to a heightened chance of M. tb disease or infection. Moreover, dependent on Dietro Ghezzi in Brighton and Sussex Medical School, oxidative stress can ultimately cause poor immune system structure and function.
Fortunately, glutathione plays an essential role in strengthening and controlling immunity. By way of instance, glutathione is essential for innate and adaptive processes within the immune system, including T-lymphocyte proliferation, phagocytic activity of polymorphonuclear neutrophils, and dendritic cell functions, which can be fundamental because these are made-up of antigen-presenting cells. Cell-meditated immunity includes protein antigens which initially begin to degenerate in the endocytic vesicles of macrophages and dendritic cells, therefore, the smaller peptides are demonstrated on the surface to activate proliferation of antigen-specific T cells. In addition, glutathione helps with the creation of cytokines, and it is necessary to maintain interferon-gamma production by dendritic cells, which is important towards protecting against intracellular pathogens including mycobacteria.
N-acetyl-cysteine, or NAC, scientifically referred to as the precursor of glutathione, is also a very powerful cellular antioxidant used as a free radical scavenger antioxidant. Commonly recognized for its role in averting acetaminophen toxicity, NAC, or�N-acetyl-cysteine, has been demonstrated to possess several health and wellness benefits. According to Cell Journal, NAC helps support a healthy inflammatory response and may positively impact human term and preterm labors. The research study concluded that in women with previous preterm birth and bacterial vaginosis, 0.6 gram of NAC per day taken orally together with progesterone after week 16 of pregnancy shielded against preterm birth recurrence and improved neonatal outcome. In conclusion, NAC’s positive effects on muscle building was also detected. After three minutes of persistent contractions, there was a 15 percent enhanced output, demonstrating how NAC plays a fundamental role in improving muscle building and reducing overall fatigue during labour.
Researchers also discovered that NAC, or�N-acetyl-cysteine, may benefit those who have polycystic ovarian syndrome, or PCOS. PCOS, or�polycystic ovarian syndrome, is a common endocrine glands-related disease which impacts approximately 5 to 10 percent of reproductive-age women. In such patients, there is a greater risk of experiencing metabolic syndrome, where the use of NAC helped restore healthy insulin levels and sensitivity.
Dr. Alex Jimenez’s Insight
Glutathione has been referred to as the “master of antioxidants” due to its fundamental role in achieving and maintaining overall health and wellness. While the human body is capable of producing its own glutathione, poor nutrition, pollution, toxins, excessive use of drugs and/or medications, stress, trauma, aging, disease and radiation can all decrease our natural levels of glutathione. This can in turn make individuals more susceptible to cell damage from oxidative stress, free radicals, infections and cancer. Glutathione supplementation can therefore have tremendous benefits on the human body. Together with alternative treatment options, such as chiropractic care, glutathione levels can once again be regulated to improve well-being.
Additionally, healthcare professionals have suggested implementing the use of glutathione supplementation together with other alternative treatment options, such as chiropractic care, to further improve overall health and wellness. Antioxidants are important towards maintaining maximum well-being as well as to inhibit the chain reaction of free radicals that cause cell harm or damage. Powerful antioxidants like glutathione, as previously mentioned above, ultimately help regulate the development of these free radicals and provide a healthier immune system response. Research studies have found that chiropractic care may also play an essential role in this process, naturally boosting the activity of antioxidants in the human body. Chiropractic care is a safe and effective treatment approach which utilizes spinal adjustments and manual manipulations to correct spinal misalignments, or subluxations, in order to allow the human body to naturally heal itself without the use of drugs/medications and/or surgical interventions.
Finally, antioxidants demonstrate their biological properties through a great deal of health benefits, which might be necessary now more than ever with the every so increasing onslaught of stress, disease and pollution in our modern world, which all contribute to cell harm and/or damage. Glutathione and its precursor, NAC, or�N-acetyl-cysteine, continue to show their powerful status in the realm of antioxidants. Together with alternative treatment options, such as chiropractic care, people can take advantage of all the benefits that this powerful antioxidant has to offer. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
El Paso, TX. Chiropractor, Dr. Alexander Jimenez focuses on degenerative and demyelinating diseases of the nervous system, their symptoms, causes and treatment.
Degenerative & Demyelinating Diseases
Motor Neuron Diseases
Motor weakness without sensory changes
Amyotrophic lateral sclerosis (ALS)
ALS Variants
Primary lateral sclerosis
Progressive bulbar palsy
Inherited conditions that cause anterior horn cell degeneration
Werdnig-Hoffmann disease in infants
Kugelberg-Welander disease in children and young adults
Amyotrophic Lateral Sclerosis (ALS)
Affects patients 40-60 years of age
Damage to:
Anterior horn cells
Cranial nerve motor nuclei
Corticobulbar and corticospinal tracts
Lower motor neuron findings (atrophy, fasciculations) AND upper motor neuron findings (spasticity, hyperreflexia)
Survival ~three years
Death results from weakness of the bulbar and respiratory musculature and resultant superimposed infection
ALS Variants
Usually eventually evolve into typical ALS pattern
Primary Lateral Sclerosis
Upper motor neuron signs begin first, but patients do eventually have lower motor neuron signs as well
Survival can be ten years or longer
Progressive Bulbar Palsy
Selectively involves the head and neck musculature
As more and more cortical areas become involved, the patient will develop more severe cognitive deficits, however paresis, sensory loss, or visual field defects are features.
Treatment Options
Medications that inhibit central nervous system acetylcholinesterase
Donepezil
Galantamine
Rivastigmine
Aerobic Exercise, 30 minutes daily
PT/OT care to maintain activities of daily living
Antioxidant and anti-inflammatory therapies
In advanced stages, may require full time, in home care
Vascular Dementia
Cerebral arteriosclerosis leading to stroke
Patient will have documented stroke history or signs of prior stroke (spasticity, paresis, pseudobulbar palsies, aphasia)
May be associated with Alzheimer Disease if due to amyloid angiopathy
Frontotemporal Dementia (Pick�s Disease)
Familial
Affects the frontal and temporal lobes
May be seen on imaging if advanced degeneration in these areas
Inability to compensate for perturbations, resulting in retropulsion
Mask-like facies
Mild to moderate dementia
Later in progression, due to lewy body accumulation
Pathology
Deficiency of dopamine in the striatum (caudate and putamen) of the basal ganglia
Dopamine normally has the effect of stimulating the direct circuit through the basal ganglia, while inhibiting the indirect pathway
Carbidopa/Levodopa
Most common treatment is a combination drug
Levodopa
A dopamine precursor that crosses the blood-brain barrier
Carbidopa
Dopamine decarboxylase inhibitor that does not cross the BBB
Amino acids will reduce effectiveness (competition) and so medication should be taken away from protein
Prolonged Treatment With Carbidopa/Levodopa
The patient�s capacity to store dopamine declines with medication use and therefore the improvements from the medications will last for shorter and shorter periods the longer the medication is used
Over time can result in proliferation of dopamine receptors
Peak-dose dyskinesia
Long term use puts stress on the liver
Other side effects can include nausea, hypotension and hallucinations
Other Treatment Options
Medications
Anticholinergics
Dopamine agonists
Dopanime breakdown inhibitors (Monoamine oxidase or catechol-O-methyl transferase inhibitors)
High dose glutathione
Brain balancing functional neuro-rehab exercises
Vibration
Retropulsive stimulation
Repeated reflex stimulation
Targeted CMT/OMT
Multiple System Atrophy
Symptoms of Parkinson Disease paired with one or more of the following:
Pyramidal signs (Striatonigral degeneration)
Autonomic dysfunction (ShyDrager syndrome)
Cerebellar finding (Olivopontocerebellar atrophy)
Generally not responsive to standard Parkinson Disease treatments
Progressive Supranuclear Palsy
Fast progressing degeneration involving tau proteins in many areas including the rostral midbrain
Symptoms usually start around ages 50-60
Gait difficulty
Significant dysarthria
Voluntary vertical gaze difficulty
Retrocollis (dystonic extension of the neck)
Severe dysphagia
Emotional lability
Personality changes
Cognitive difficulty
Does not respond well to standard PD treatment
Diffuse Lewy Body Disease
Progressive dementia
Severe hallucinations and possible paranoid delusions
Confusion
Parkinsonian symptoms
Multiple Sclerosis
Multiple white matter lesions (plaques of demyelination) in the CNS
Variable in size
Well-circumscribed
Visible on MRI
Optic nerve lesions are common
Peripheral nerves are not involved
Uncommon in children under 10, but usually presents before age 55
Viral infection may trigger an inappropriate immune response with antibodies to a common virus-myelin antigen
Infectious and immune mechanisms contribute
Types Of MS
Primary progressive MS (PPMS)
Secondary progressive MS (SPMS)
Relapsingremitting multiple sclerasis (RRMS)
Most common type
Can develop acutely, spontaneous appear to resolve and return
Eventually becomes like SPMS
Optic Nerve Involvement
In 40% of MS cases
Pain with eye movements
Visual field defect (central or paracentral scotoma)
Funduscopic examination
May reveal papilledema if the plaque involves the optic disk
May not appear unusual if plaques are behind the optic disk (retrobulbar neuritis)
Medial Longitudinal Fasciculus Involvement
Demyelination of the MLF results in internuclear ophthalmoplegia
During lateral gaze there is paresis of the medial rectus and nystagmus of the contralateral eye
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Church, Archibald. Nervous and Mental Diseases. W.B. Saunders Co., 1923.
