Cognitive Issues & Treatments for PwMS/CCSVI


I wrote this 4 years ago. Since then I realize that some symptoms of cognitive dysfunction were omitted. Perhaps I did so purposely because they may have hit too close to home. At the conclusion of the five year clinical study for CCSVI in which I took part, I was given the privilege of reading some results that I have given much thought to since August. Cognitive issues MS/CCSVI or what ever you have chosen to call our condition included are far more complex than I realized. It is my intention to address this issue in greater detail as I prepare a video and article which will chronicle in greater detail my almost 20 year journey through MS.

Of the 50 various MS symptoms I had, cognition, cog fog, MS brain farts, “old timer’s” disease or what ever else you want to call it was by far the most crippling and self-esteem destroying hell I have ever lived through. I have made a few observations:

Cognitive impairment occurs when problems with thought processes occur. It can include loss of higher reasoning, forgetfulness, learning disabilities, concentration difficulties, decreased intelligence, and other reductions in mental functions.

If either memory, or thinking were somehow disrupted, then our ability to process information would be impaired.

Some treatments that have proven to be effective in some people

ACETYL-L-CARNITINE: 1500-4000 mg daily (caution: do not take with blood thinners like Warferin)It also improves blood flow which makes sense for PwMS/CCSVI

  • CITICOLINE: Age-related memory problems. Citicoline seems to help memory loss in people aged 50 to 85 years.
  • Stroke recovery. Stroke patients who take citicoline by mouth within 24 hours of having the kind of stroke that is caused by a clot (ischemic stroke) are more likely than other ischemic stroke patients to have a complete recovery within 3 months.
  • Long-term blood circulation problems in the brain (cerebrovascular diseases). There is some evidence that citicoline taken by mouth or given by IV or as a shot might improve memory and behavior in patients with long-term cerebro-vascular diseases, such as stroke.
  • PHOSPHATIDYLSERINE:  100 mg of phosphatidylserine three times daily.

Description of the how we use our cognitive skills:

  •  focus, maintain and divide attention (concentration)
  • learn and remember new things
  • think, reason and solve problems
  • plan, carry out and monitor our own activities
  • understand and use language
  • recognize objects and assemble things together
  • judge distances (spatial skills)
  • Language processing, concentration and memory problems are the most common symptoms of cognitive dysfunction.
  • ‘Word Fishing” is a common complaint relating to language use, where the person knows what they would like to say but is unable to ‘find the words’.
  • Concentration may result in a person beginning a task, becoming distracted by another but beginning the new task before finishing the first, and so it goes on and on, until there are numerous unfinished chores or tasks.
  • Memory problems too, present a challenge for people with multiple sclerosis, particularly short term memory. This tends to show itself as a failure to remember basic things such as the name of a familiar item or animal, for example.
  • The range of cognitive dysfunctions which can be associated with multiple sclerosis:
  • Verbal fluency and language skills can be impaired
  • Intellectual reasoning can be impaired
  • Inability to learn quickly
  • Poor problem solving abilities
  • Information processing can be slowed
  • Poor concentration
  • Poor judgment
  1. 1.       The majority of people with MS/CCSVI are/were multi-taskers. Someone who can dovetail their projects and complete them is usually is an “A” personality. 10% of people with multiple sclerosis, the impairment to their cognitive functioning will eventually become severe enough to significantly interfere with daily living.
  2. The ones who multitask are the most likely to suffer from cognitive problems. (This is not written in stone, however)
  3. When a brain cell dies, it does not regenerate, it is gone. The brain being the marvelous work and wonder that it is can compensate for a considerable amount of cell death. Even with no formal retraining the brain will often pass the cerebral baton to another part of the brain and learn to compensate for tissue degradation elsewhere.
  4. It is wise to prepare the brain to “cross train “ before the time it becomes a necessity.
  5. A person with MS can develop this symptom at anytime. You may go for ten years with little or no cognitive issues and then find yourself wondering what year it is.
  6. Cognitive problems usually occur over time. Since the person developing the problem may only have a vague feeling that something is wrong, it is often a friend or c0-worker who mentions your changed sense of awareness.
  7. Cognitive impairment may accompany symptoms related to infection including:
  • Fever
  • Headache
  • Malaise or lethargy
  • Muscle twitching, spasms or seizures
  • Nausea with or without vomiting
  • Rash
  • Stiff or rigid neck

BTW: other causes of cognitive problems are:

  • chromosome abnormalities and genetic syndromes,
  • malnutrition
  • prenatal drug exposure
  •  poisoning due to lead or other heavy metals
  • hypoglycemia (low blood sugar hypothyroidism (underactive thyroid), complications of prematurity, trauma or child abuse such as shaken baby syndrome, or oxygen deprivation in the womb or during or after birth

Cognitive impairment that develops in childhood or adolescence can result from many conditions.

  • Examples include side effects of cancer therapy,
  • malnutrition
  • heavy metal poisoning,
  • autism (abnormal development of communication and social skills), metabolic conditions
  • systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)

With age, other conditions such as stroke, dementia, delirium, brain tumors, chronic alcohol use or abuse, substance abuse, some vitamin deficiencies, and some chronic diseases may cause cognitive impairment. Head injury and infection of the brain or of the covering of the brain and spinal cord (meninges) can cause cognitive impairment at any age.

Cognitive impairment may accompany other symptoms related to metabolic disorders including:

  • Abdominal pain
  • Abnormal heart rhythm such as rapid heart rate (tachycardia) or slow heart rate (bradycardia)
  • Changes in skin
  • Confusion or loss of consciousness for even a brief moment
  • Difficulty breathing or rapid breathing
  • Nausea with or without vomiting
  • Fatigue
  • Feeling very thirsty
  • Frequent urination or decrease in urine output
  • Fruity breath
  • Muscle weakness

8.Cognitive impairment may accompany symptoms related to other problems, such as injury, stroke or dementia. These symptoms may include:

  • Change in sleep patterns
  • Changes in mood, personality or behavior
  • Confusion or loss of consciousness for even a brief moment
  • Difficulty with memory, thinking, talking, comprehension, writing or reading
  • Impaired balance and coordination
  • Loss of vision or changes in vision
  • Nausea with or without vomiting
  • Numbness, weakness or paralysis
  • Seizure
  • Severe headacheImage

Baclofen & other Anti-Spasmotics versus Magnesium


Muscle Spasticity & Baclofen:

 

Baclofen and Zanaflex are two medications prescribed every day for muscle spasticity or spasms and tremors. They both can relieve this frustrating MS symptom but long term use can cause the muscles to weaken and become flaccid.

Baclofen is a muscle relaxant that works by inhibiting the reflexes at the spinal cord level.  It is not selective for just hyperactive reflexes, however.  It inhibits or depresses many aspects of the central nervous system.  As a result, it can be effective at reducing severe muscle spasticity, but it also produces common side effects such as drowsiness, dizziness, slurred speech, and confusion.  New, long-term side effects revealed by several studies are muscle weakness and fatigue.

Use of baclofen with other drugs that also depress the function of nerves may lead to additional reduction in brain function. In addition to the risk of depressing brain function, the use of baclofen and tricyclic antidepressants ( amitriptyline ,Elavil, Endep, doxepin Sinequan, Adapin together causes muscle weakness. Low blood pressure is another side effect to consider even short term.

 

Diabetics will need to make adjustments in their glucose control as baclofen can substantially raise blood glucose levels.

Baclofen may cause drowsiness, weakness, dizziness, headache, seizures, nausea, vomiting, low blood pressure, constipation, confusion, respiratory depression, inability to sleep, and increased urinary frequency or urinary retention. It is well known that too much anti-spasmadics can lead to muscle atrophy. One recent study showed that 27% of patients who used baclofen for over 1 year developed muscle atrophy , primarily in the calves and thighs.

 

 

 There are safer alternatives. Magnesium is an OTC supplement that can reduce muscle spasms. Magnesium has been used widely for clinical manifestation of muscle cramps, with good success. Research has shown that it is not just deficient individuals that benefit from supplementation, rather it has been hypothesized that everyone can benefit from its ability to stabilize cellular membranes. Magnesium is critical to cellular functioning in terms of energy production, cell reproduction, and protein formation. It is essential for energy production. A blood test is needed to determine the blood magnesium level before starting magnesium supplements. If the blood level is low or even normal, then body magnesium stores may be low. Unfortunately, a normal blood level does not ensure that body magnesium stores are adequate. The RDA is below what the body needs to relieve spasticity. Too much can cause diarrhea. For people taking medications to relieve MS symptoms, that could actually be a plus as many of them cause constipation.

 

Because of the effectiveness of magnesia and muscle cramps it is often given in the doctor’s office intravenously.

Magnesium is an important element in the body because it activates or is involved in many basic processes or functions, like:

 

1. Cofactor for over 300 enzymes;

2. Oxidation of fatty acids;

3. Activation of amino acids;

4. Synthesis and breakdown of DNA;

5. Neurotransmission;

6. Immune function;

7. Interactions with other nutrients, including potassium, vitamin B6, and boron.

500 mg three times a day is a reasonable dosage, however the blood testing should be done first.

 

CAUTION: Abrupt discontinuation of oral baclofen may cause seizures and hallucinations. Abrupt discontinuation of intrathecal baclofen may result in high fever, rebound spasticity, muscle rigidity, and muscle breakdown that can progress to failure of several organs, including the kidney, and even death. If you are taking Baclofen regularly you have to taper off not try to do it cold turkey. In the meantime, the magnesium can be stared before you discontinue baclofen.

 

http://www.themiamiproject.org/Document.Doc?id=196 

 

Magnesium information:

In a recent study analyzing the diet of 564 adult Americans, both male and female, the average intake of magnesium was less than two-thirds of the RDA for men and less than 50% of the RDA for women. This means that men, on average, are getting under 200 mg. magnesium daily and women get under 150 mg. per day. When you take into consideration the current RDA is less than half of the probable adequate amount of magnesium you begin to see the scope of the deficiency problem.

 

How to Take Magnesium and What Kind of Magnesium to Take:

SPECIAL NOTE ON CALCIUM- High calcium intake may block uptake and utilization of magnesium. Current available research seems to indicate that calcium intake be twice than or equal to magnesium intake. In spite of publicized research proclaiming high calcium intake as a positive health factor, in-depth review of research shows that high calcium intake contributes to many degenerative diseases and is a health risk factor.

IMO magnesium chelates as the only reliable sources to replete magnesium. Magnesium is available in chelated (bound to) combinations such as alpha-ketogluconate, aspartate, glycinate, lysinate, orotate, taurate and others. Inorganic or ionic magnesiums include sulphate, oxide, citrate, carbonate, bicarbonate and chloride. Some supplement companies make so-called chelated magnesiums but the chelate (bound to) is partial and the raw material contains some percentage of ionized, unbound or inorganic magnesium. Ionized magnesium may cause diarrhea in many users and, therefore, not correct a cellular magnesium deficiency. Diarrhea, or soft stools, caused by any form of magnesium can make a magnesium deficiency worse.

 

The best food sources of magnesium are chocolate, nuts, seeds, and deep, dark, leafy greens.

 

Magnesium should be taken with your other supplements and/or food. Split your supplemental intake into 2 or more doses daily. Some magnesium supplements can be energizing and in some persons may have a negative impact on getting to sleep and staying asleep when taken near bedtime. If taken in the correct dose and early enough in the day magnesium often corrects insomnia. Taking  magnesium late in the day is not a problem if it does not adversely affect your sleep.