Has the description of the Uhthoff phenomenon complicated rehabilitation in multiple sclerosis?
Journal Title: Rehabilitacja Medyczna - Year 2009, Vol 13, Issue 1
Abstract
Professor Wilhelm Uhthoff described for the first time in 1890 that increased body temperature from physical exertion may lead to transient impairment of vision in patients with multiple sclerosis (MS). In his report entitled: “Untersuchungen über die bei der multiplen Herdsklerose vorkommenden Augenstörungen“ he described within four out of a 100 patients with MS a marked deterioration of visual acuity during physical exercise and exhaustion. This vision, referred to as retrobulbar optic neuritis, was later named after him as “Uhthoff phenomenon”. Until 1983 “the hot bath test” was accepted as a clinical test and used for diagnosing MS, subsequently being replaced by more specific investigations. Now it is known that the Uhthoff phenomenon and the characteristic deterioration of MS symptoms by increased body temperature due to physical exercise may also be observed with triggering factors such as fever, hot meals, weather, menstruation, but also smoking and psychological stress. For a long time it was not clear as to whether the nervous conduction velocity in demyelinated fibres was influenced directly by heat or whether it was due to indirect phenomena. In 2004 Humm et al. stated that Uhthoff phenomena in the motor system are due to varying degrees of conduction block and are associated with prolonged central motor conduction time. Multiple sclerosis (MS) is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicaps. Uhthoff phenomenon has defined the strategy of rehabilitation procedures in MS for more than a 100 years. Heat therapy and physical exercises were restricted because of fear of a flare up of the disease, and aquatic exercises were limited to a water temperature of 30°C. In recent years something has changed though. A few reports on randomised controlled trials of progressive exercise programmes, mainly consisting of resistance training for a few months have been published. The findings from these studies suggest overall disability and mobility improvement with aerobic training. All types of rehabilitation should be tailored to fit a patient’s specific needs. The first report to describe the successful outcome of a comprehensive rehabilitation programme that included aquatic therapy with a pool temperature above 30°C in a MS patient has been published. Based on the Uhthoff phenomenon, therapeutic trials with cooling jackets are being investigated and developed. In this review there is reported the current state concerning the Uhthoff phenomenon and its influence on comprehensive rehabilitation in MS.
Authors and Affiliations
Józef Opara, Waldemar Szwejkowski, Zenon Pidsudko
Keywords
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