Benefits of intravascular laser Irradiation of Blood on Motor and Sensory Recovery Viewing from Brain Function Images: Portrait of a Case with Chronic SjÖgren's Syndrome, Transverse Myelitis, and GuillainBarré Syndrome
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 4
Abstract
Transverse myelitis is an autoimmune disease and often causes paralysis of the lower limbs. The Guillain-Barré syndrome is characterized as sensorimotor disturbance and progressive limbs weakness from lower limbs and progresses symmetrically upward. Deafferent pain syndrome is also common. Combination of both diseases will worsen the consequences, and results in various disabilities. Conventional treatments cannot achieve the fast recovery of the motor and sensory dysfunction, and the intravascular laser irradiation of blood comes with the tide of fashion, which has been reported with efficacy in facilitating the circulation and increased wound healing rate. We herein report a case with Sjögren’s syndrome combined with two other diseases, who obtained better motor and sensory recovery after 2-courses of laser therapy. A close relationship between motor/ sensory function and the dorsolateral prefrontal cortex was observed from the brain function images. Transverse myelitis (TM) is an autoimmune disease and often causes paralysis of the lower limbs, which motor impairment is characterized by flaccid paraplegia in the initial phase, and later a spastic paraparesis with tendinous hyperreflexia [1]. The Guillain-Barré syndrome (GBS), an acute inflammatory demyelinating polyradiculoneuropathy, is the most common cause of acute generalized paralysis, which clinical manifestations are sensorimotor disturbance and progressive limbs weakness. It usually presents as a paralysis that starts in the lower limbs and then progresses symmetrically upward. Deafferent pain syndrome is common in the early stages of recovery in GBS [2]. Combination of both TM and GBS will worsen the consequences, and results in various disabilities. Conventional treatments are effective in medical control, for instance, intravenous immunoglobulin [1], plasma exchange [3,4]. Motor and sensory recovery depend on adequate rehabilitation [5,6], or virtual motor rehabilitation program [2]. However, those rehabilitative ways are slow and difficult in meeting some needs. A novel method is always an expected way in order to have a faster recovery; therefore, the intravascular laser irradiation of blood (ILIB) comes with the tide of fashion. ILIB has been applied to multiple disciplines like cardiovascular events [7,8], rheumatology-related arthritis [9-11], fibromyalgia [12], hepatology [13], obstetrics (parturient patients for postpartum mastitis and nipple soreness) [14] and diabetes mellitus [15-17], as its properties of increasing microcirculation and improving oxygen supply. It is reported with efficacy in facilitating the circulation and increased wound healing rate [18,19]. We herein report a case with TM combined with GBS, who was treated with ILIB and obtained better motor and sensory recovery A 43-year-old woman with underlying Sjögren’s syndrome (SS) and experienced a prior episode of acute gastroenteritis, which caused to development of TM and GBS 3-4 years ago. Bilateral lower limbs numbness and weakness (muscle power score 2-3) caused her as to disable, and under the standard treatment of steroid pulse therapy and immunomodulators, she could reluctantly walk with the help of quadricane. However, severe neuropathic pain at T4-T5 level with Visual Analogue Scale (VAS): 8-10 persisted without any recovery at all. She came to our outpatient department for better walking ability and pain relief. Berg Balance Score recorded as 8/56. The regional cerebral perfusion scan with single photon emission computed tomography (SPECT) was performed and showed decreased activities in the frontal area. Two courses of ILIB were provided (ten consecutive days each course with resting interval of 7-14 days). The procedure of ILIB was mentioned as before [20]. In brief, insertion of an optic fiber was inserted into a superficial vein in order to convey laser light. Helium–neon (He-Ne) laser (YJ-ILIB-5, Bio-ILIB Human Energy Ltd, Taiwan) was applied with wavelength of 632.8 nm, power output 2.5 to 3.5w/cm2 , power intensity 1.79 to 2.04 w/cm2 , energy 12.6 to 14.4 J, energy density 6428.57 J/cm2 , and irradiation time 3600 s/ session. We adjusted power output depending on the patient’s responses. After completeness of two courses of ILIB, neuropathic pain diminished to VAS 1-2, and the weakness of the both lower limbs improved (muscle power from 2-3 to 4-5). We tested her posture performance, which showed independent standing without obvious tilting nor body shaking, standing with eyes closed independently, and standing on right leg 3.5 seconds and left leg 2.5 seconds, even still difficulty in jumping on one leg. The second Berg Balance Score recorded as 46/56. She could walk steadily for 3 meters, staggering while turning around. She could walk with minimal help but need a pause when she made a turn (Figure 1). The second brain SPECT showed increased activities in the frontal area (Figure 2).
Authors and Affiliations
Esther Yi Liu, Shin-Tsu Chang
Keywords
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- EP ID EP594352
- DOI 10.26717/BJSTR.2019.14.002572
- Views 168
- Downloads 0
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