Paroxysmal itching in multiple sclerosis during treatment with external magnetic fields

Botulinum toxin type A therapy for bilateral focal neuropathic pruritus in multiple sclerosis: a case report

Neuropathic pruritus is a form of chronic itch that occurs in the presence of direct damage to the nervous system. It tends to be severe, disabling, and difficult to treat. Usual antipruritic medications are largely ineffective and there is no consensus regarding the treatment approach. The authors report a case of a 58-year-old man with primary progressive multiple sclerosis and a history of unsatisfactory management of severe bilateral focal pruritus. Significant symptom relief was attained after local intradermal injections of botulinum toxin type A.

An Unusual Presentation of Multiple Sclerosis in a Middle-Aged Woman: A Case Report and Literature Review

An intense itching localized to dermatomes is a rare symptom of multiple sclerosis (MS). Herein, we report a case of a 45-year-old female who presented with severe itching and tingling sensation, gait disturbance, and bilateral paresthesia for one week. She also had a history of multiple admission in the hospital due to recurrent walking abnormalities and numbness and tingling of both hands associated with intermittent psychiatric symptoms. The neurological examination revealed spastic quadriparesis with lower limb muscles affected more than the upper limbs, numbness, and sensory loss in the upper extremities in the glove and stocking pattern. Magnetic resonance imaging (MRI) revealed multiple small rounded periventricular plaques in both hemispheres and along the long axis of the corpus callosum (fluid-attenuated inversion recovery/FLAIR sequence), and cerebrospinal fluid analysis revealed the presence of oligoclonal bands, suggestive of MS. She was commenced on methylprednisolone and carbamazepine, leading to progressive resolution of her signs and symptoms. She was discharged with monthly natalizumab, and she was doing well on her follow-up.

Extremely Low-Frequency Pulsed Magnetic Fields and Multiple Sclerosis: Effects on Neurotransmission Alone or Also on Immunomodulation? Building a Working Hypothesis

This paper outlines the current state of knowledge on the pathology and treatment of multiple sclerosis (MS) and critically analyses the vast clinical experience of Sandyk in the use of pulsed magnetic fields of 5 Hz at 7.5 pT to treat many symptoms of MS. A complete regression of symptoms, or at least a major improvement, is sometimes so rapid as to suggest that ELF fields exert a greater effect on axonal and synaptic neurotransmission than on the processes leading to demyelination. Pulsed magnetic fields of 50–100 Hz and a few mT (whose flux intensity is 109 times greater than that of the fields used by Sandyk) have been seen to induce profound morphological changes (the Marinozzi effect) in the plasma membrane of several cell types, including Raji human lymphoblastoid cells. These observations underlie the author's hypothesis on the possible use of such fields in the treatment of MS. Indeed, these fields should induce the functional arrest of the cells (B- and T-lymphocytes, macrophages, microglia, dendritic cells) of the MS plaque, thereby providing an ‘electromagnetic immunomodulatory boost’ to the effects of drug therapy. To test this working hypothesis, it is suggested that preliminary experimental research be carried out to ascertain: 1) the Marinozzi effect in vivo; 2) the Marinozzi effect on microglia and dendritic cells; and 3) the duration of the membrane changes and their relaxation rate. ELF magnetic fields in the picotesla and millitesla ranges are aimed at improving neurotransmission and correcting local immune pathology, respectively. Both types of field might find application in the treatment of MS patients who no longer respond to or tolerate currently used drugs.

Neuropathic pruritus (itch) in neuromyelitis optica

BACKGROUND

Neuropathic pruritus (itch) is an uncommon, but well described, symptom in neurology. There are itch-specific neurons in the dorsal horn of the spinal cord. We noted excessive pruritus in patients with neuromyelitis optica (NMO).

OBJECTIVE

We aimed to explore the characteristics of pruritus in NMO patients.

METHODS

We reviewed case records of a well-defined cohort of 45 serial aquaporin-4 antibody-positive patients visiting the national NMO service. All patients were interviewed.

RESULTS

Of the 45 antibody-positive NMO patients, 44 had myelitis and 12 of those 44 (27.3%) patients reported pruritus within a week of other symptoms of transverse myelitis with central cord involvement. In three patients, pruritus was the first symptom of a relapse, while in one case, pruritus was the very first symptom of the index episode of NMO.

CONCLUSION

Neuropathic pruritus seems to be a common, but under-recognised symptom of myelitis associated with NMO.

Itch

Itch is a common skin sensation, with substantial effects on behaviour. Neurophysiological research has permitted accurate definition of neural pathways of itch, and has confirmed the distinctiveness of itch pathways in comparison with pain. A clinical classification of itch, based on such improved understanding, describes the difference between peripheral (pruritoceptive) and central (neurogenic or neuropathic) itch. New specific and sensitive investigational methods in people and animals enable us to better understand this bothersome symptom, and have important clinical implications. We describe the clinical classification of itch, new findings on neuropathophysiology of itch, methods for assessment, and improved treatments.

Therapeutic effects of alternating current pulsed electromagnetic fields in multiple sclerosis

Multiple sclerosis is the third most common cause of severe disability in patients between the ages of 15 and 50 years. The cause of the disease and its pathogenesis remain unknown. The last 20 years have seen only meager advances in the development of effective treatments for the disease. No specific treatment modality can cure the disease or alter its long-term course and eventual outcome. Moreover, there are no agents or treatments that will restore premorbid neuronal function. A host of biological phenomena associated with the disease involving interactions among genetic, environmental, immunologic, and hormonal factors, cannot be explained on the basis of demyelination alone and therefore require refocusing attention on alternative explanations, one of which implicates the pineal gland as pivotal. The pineal gland functions as a magnetoreceptor organ. This biological property of the gland provided the impetus for the development of a novel and highly effective therapeutic modality, which involves transcranial applications of alternating current (AC) pulsed electromagnetic fields in the picotesla flux density. This review summarizes recent clinical work on the effects of transcranially applied pulsed electromagnetic fields for the symptomatic treatment of the disease.