Multiple sclerosis (MS) is a chronic, complex, and often disabling disease of the central nervous system (CNS) with a variable clinical course. There are two basic forms of MS – relapsing/remitting and progressive. There is significant overlap between these two forms. Patients with MS have inflammation, demyelination, scarring of brain tissue, nerve cell degeneration, and dysfunction resulting from dysfunction of the immune system. Inflammation causing demyelination predominates in the relapsing remitting phase of the disease and is seen as recurrent episodes of worsening and improvement (exacerbation and remission). Neurodegeneratiion, leading to extensive brain nerve cell (neuronal) damage, occurs at the same time as the inflammatory process in progressive stages of the disease.
MS affects more than 2.1 million people worldwide and over 400,000 individuals in the United States, with about 200 new patients diagnosed every week. Although it can affect individuals at any age, MS is usually diagnosed between the ages of 20-40 years and is approximately 3 times more common in women than in men. As a leading cause of disability in young adults, MS substantially affects an individual’s quality of life and can cause a major financial and functional burden on the patient, family, and health care system.
Signs and Symptoms
The main symptoms of MS can vary by patient and may change or fluctuate over time. For many years MS has been considered a white matter disease (i.e., involving sensory and motor findings). Magnetic resonance imaging (MRI) has allowed us to see that MS lesions occur in grey matter too (i.e., involves cognitive behavior), leading to a wider range of complex neurologic symptoms.
Some of the more common symptoms may include varying degrees of vision problems, fatigue, paresthesia, bladder/bowel/sexual dysfunction, gait problems, spasticity, dizziness/ vertigo, pain, depression, and cognitive dysfunction. Less common symptoms may include headache, hearing loss, seizures, tremors, incoordination, and speech and swallowing difficulties. These symptoms may lead to additional secondary complications, e.g., urinary tract infections, loss of muscle tone, decreased bone density, shallow breathing, pressure sores, and tertiary, e.g., social, vocational, and psychological complications, which create their own challenges to effectively treat and manage.
Because MS is diagnosed at a relatively young age (20 to 40 years), and continues to evolve over time, it causes a greater economic burden than many other chronic diseases over the lifespan of the individual and has a huge impact on health, quality of life, productivity, and employment over many years.
No one knows what causes MS. It is influenced by multiple interacting genetic, environmental, nutritional, hormonal, and viral factors. It is also correlated with geophysical parameters, such as sunshine exposure and variations in the Earth’s magnetic field, both of which are a function of location and seasonal influences.
Treatment of MS has advanced significantly over the past several decades. Historically, MS treatment was mostly supportive in decreasing the severity of exacerbations (MS attacks), relying on short-courses of powerful steroids. In the 1990s disease-modifying therapies (DMTs) began to be used for long-term treatment, to proactively manage and retard disease progression. While DMTs have benefits in reducing the occurrence of relapses and future disability, they can have important side effects. Despite their popularity and heavy reliance with doctors, they do not work equally well in everybody, reducing relapse rates only by only about 30%.
There is no consensus as to which DMT should be used for what type of MS patient. There are no studies that have evaluated which therapies are most appropriate for a particular MS patient group. The benefits of typical DMTs happen over long periods of time, typically beyond 4 years. This is another reason why new options for shorter term therapies are necessary for the comprehensive and total management of MS.
Generally, treatment with traditional therapy is considered relatively safe. The most frequently adverse effects include: injection-site reactions, flu-like symptoms, fatigue, muscle pains, elevation of liver enzymes, blood abnormalities, fat atrophy, infections, post-infusion reactions, and progressive multifocal encephalopathy (PML)- an often fatal demyelinating disease of the central nervous system. PML has been confirmed among 104,300 patients treated with natalizumab, 62 being fatal. Mitoxantrone may cause therapy-related acute leukemia and cardiotoxicity. Fingolimod can lead to cardiac abnormalities such as slow heart rate and heart block, hypertension, liver and respiratory changes, infections, and macular edema. Teriflunomide and leflunomide may cause diarrhea, elevated liver enzymes, nausea, flu-like symptoms, and thinning or loss of hair, embryo-lethal effects in some animals. BG-12 has been associated with flushing (30%-40%) and gastrointestinal symptoms (e.g., diarrhea, nausea/vomiting, abdominal pain; about 20%). Alemtuzumab may cause hyperthyroidism and auto-immune thrombocytopenic purpura (ITP), and increased risk for super-infections and cancers.
So, given all these limitations of current approaches to managing MS, this is yet another reason that new approaches are needed.
Magnetic field therapy
In the search for other therapies to help manage MS, I have become aware of the potential for pulsed electromagnetic fields (PEMFs) to impact neurological tissue at a fundamental level. While there is little evidence at this time to suggest that PEMFs may actually be able to reduce plaque size, there is some suggestion that there is a possibility that PEMFs may be able to reduce recurrences and perhaps delay progression of MS as well.
Research suggests that PEMFs – although not a cure – can alleviate many of the major symptoms of MS, including spasticity, fatigue, cognitive function, mood changes and other impaired physiologic functions. This is because PEMFs act at such basic cellular and physiologic levels. They improve the function of all cells of the body, even those impaired by any specific disease process, such as MS. As such, PEMFs can substantially enhance the quality of life of individuals with MS without the side effects associated with pharmaceutical approaches.
Because every molecule, cell, organ in our body emits and is sensitive to electromagnetic fields, our biochemistry is influenced by our electromagnetic nature. As such, efforts to develop new therapies based solely on dysfunctional biochemistry without considering this nature ultimately will be limited. It is like replacing worn auto tires without aligning the wheels that caused the tires to get worn in the first place, i.e., you need to tackle both problems, so they don’t recur.
Although there is no tissue in which our electromagnetic nature is more evident than MS-attacked nervous tissue, most therapeutic efforts have emphasized the disease’s overt physical symptoms associated with demyelination. They also minimized, until recently, the role of its less understood, underlying electromagnetic dynamics.
Electromagnetic fields influence many biochemical and physiological processes. Although the specific mechanisms by which such fields alleviate MS symptoms remain undefined, many possibilities exist. For example, through influencing the flow of charged ions through membrane-transversing, protein channels, electromagnetic fields may enhance signal conduction in dysfunctional neurons. In another example, magnetic fields alter our neuro- and immunochemistry, both of which are affected by MS.
Electromagnetic fields influence the levels of various MS-altered hormones. Dr. R. Sandyk (Touro College, NY) has intriguingly suggested that a key player in the disease’s etiology is the brain’s all-important, magnetically and light-sensitive pineal gland, which secretes hormones (e.g., melatonin) that affect the entire body (J. Alternative & Complementary Medicine, 1997; 3(3): pp 267-290).
The epidemiology, pathogenesis, clinical manifestations, and disease course of MS can all be correlated with the pineal gland. For example, most individuals with MS have calcified (i.e., dysfunctional) pineal glands. If MS demyelination is a secondary consequence of pineal dysfunction, Sandyk believes research efforts should focus on therapeutic interventions, such as magnetic therapy, that enhance pineal functioning. [Interestingly, quadriplegics, but not paraplegics, also have dysfunctional pineal glands (Zeitzer JM et al. J. Clinical Endocrinology & Metabolism, 2000; 85(6): pp 2189 –2196)]
Magnetic field therapeutic interventions reviewed below use PEMFs in which an electromagnet is turned on and off at a defined frequency. For example, a field that is pulsed 25 times per second has a frequency of 25 cycles/second or Hertz.
Field strength is defined by gauss. For reference, the Earth’s magnetic field is about 0.5 gauss, a refrigerator magnet is about 10 gauss, and some medical applications, such as MRIs, can exceed 10,000 gauss. However, because size counts, the Earth’s low intensity, large size, field profoundly influences life, including MS expression. The following studies use weak electromagnetic fields, which scientists believe can initiate physiological responses that much stronger fields often cannot. These researchers have postulated a “window effect,” in which these responses may only be initiated at a unique combination of frequency, intensity, and polarity relative to the Earth’s magnetic field.
But despite the theories, is there evidence that PEMFs affect brain function? Behavioral and neurophysiological changes have been reported after exposure to extremely low frequency magnetic fields (ELF-MF) both in animals and in humans. Even in the nonliving human neuronal cultures exposed to extremely low frequency PEMFs show an increase in excitatory neurotransmission. Excitatory neurotransmitters turn functions on, and inhibitory neurotransmitters reduce functions.
Using transcranial brain stimulation, Capone studied noninvasively the effect of PEMFs on several measures of cortical excitability in 22 healthy volunteers, and in 14 sham field exposure was used. After 45 min of PEMF exposure, intracortical facilitation function related to cortical glutamatergic activity was significantly enhanced by about 20%, while other parameters of cortical excitability remained unchanged. Sham field exposure produced no effects. This study shows some indication that PEMFs can produce functional changes in human brain.
There is growing evidence in the literature of the beneﬁcial eﬀects of magnetic ﬁelds on diﬀerent MS symptoms. Guseo reported that the technique can alleviate symptoms such as fatigue, bladder control, and spasticity, as well as improve quality of life. Richards et al. performed a double-blind study to measure the clinical and subclinical eﬀects of a magnetic device on disease activity in MS and showed that a magnetic ﬁeld improved the performance scale (PS) combined rating for bladder control, cognitive function, fatigue level, mobility, spasticity, and vision. Nielsen et al. showed in 38 MS subjects that magnetic stimulation on spasticity could improve self-score of ease of daily activities and clinical spasticity.
Regarding fatigue, commonly seen in MS, Sandyk proposed that depletion of neurotransmitter stores in damaged neurons may contribute signiﬁcantly to the development of fatigue and showed that a picotesla PEMF in a small group of MS subjects improved fatigue. These results suggestedthat replenishment of neurotransmitter stores in neurons damaged by demyelination in the brainstem by periodic applications of picotesla PEMFs may lead to more eﬀective impulse conduction and thus to improvement in fatigue.
Another possibly related way pulsed PEMFs might remediate MS fatigue is through electrophysiological eﬀects. Richards et al. found that in MS patients, during a language task and after visual stimulation, EMFs increased the amount of brain alpha activity. G. Another study showed signiﬁcan positive t diﬀerences in theta and beta band amplitudes between subjects exposed to real and sham 3 Hz magnetic ﬁelds (Heusser).
Very low intensity PEMFs
Sandyk (1998) found that transcranial applications of pico Tesla AC PEMFs produced rapid and sustained improvement of symptoms in patients with chronic progressive or secondary progressive MS, and evidence of normalization of electrophysiologic evoked potential responses. He further discovered recurrent episodes of uncontrollable yawning and body stretching, identical to those observed upon awakening from physiological sleep. This behavioral response has been observed exclusively in young female patients who are still fully ambulatory with a relapsing remitting course of the disease. This is a distinctly favorable therapeutic response to magnetic stimulation. This response is likely due to the production of adrenocorticotropic hormone (ACTH) stimulated by the PEMFs. There is support for this possibility in other research. Intracerebral administration of adrenocorticotropic hormone (ACTH) in experimental animals elicits yawning stretching behavior. A surge in plasma ACTH levels at night and just prior to awakening from sleep is also associated in humans with yawning and stretching behavior. In addition, ACTH is sometimes used to treat MS due to its immunomodulatory effects.
Sandyk (1997) describes the use of PEMFs in a woman with chronic progressive (CP) MS. A 40 year-old woman presented in December of 1992 with CP MS with symptoms of spastic paraplegia, loss of trunk control, marked weakness of the upper limbs with loss of fine and gross motor hand functions, severe fatigue, cognitive deficits, mental depression, and autonomic dysfunction with neurogenic bladder and bowel incontinence. Her symptoms began at the age of 18 with weakness of the right leg and fatigue with long distance walking and over the ensuing years she experienced steady deterioration of functions. In 1985 she became wheelchair dependent and it was anticipated that within 1-2 years she would become functionally quadriplegic. In December of 1992 she began experimental treatment with pico Tesla PEMFs. While receiving regular weekly transcranial PEMF treatments over the next year, she experienced improvement in mental functions, return of strength in the upper extremities, and recovery of trunk control. During the second year she experienced the return of more hip functions and recovery of motor functions began in her legs. For the first time in years she could initiate flexion of her ankles and actively extend her knees voluntarily. Over the next year she started to show signs of redevelopment of gait. With enough function restored in her legs, she began learning to walk with a walker and was able to stand unassisted and maintain balance for a few minutes. She also regained about 80% of the functions in her upper limbs and hands. Most remarkably, there was no further progression of the disease during the 4 year course of magnetic therapy. This patient’s clinical recovery cannot be explained on the basis of a spontaneous remission. He suggested that pulsed applications of PEMFs affect the neurobiological and immunological mechanisms underlying the pathogenesis of CP MS. but, these regenerative changes in the brain require a long course of treatment, possibly forever.