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Case Histories

Multiple Sclerosis: Male, white, was in a wheelchair at a Veterans Hospital for two years. Patient seen while home on 30-day vacation. Treatment given every day with marked improvement. Upon returning to Veterans Hospital, the physician in charge recognized the improvement and advised the young man to return home and continue the treatment. After three years, he was given a clean bill of health by three neurologists in three different places and was given a responsible position. This was in 1950. The individual remains in excellent health, but continues with modified therapy.

Myasthenia Gravis: Male, white, receiving treatment from nearby medical centre for one year. He was receiving guanadine (amount unknown) and 90 mg. prostigmine bromide each day. He was first seen in a Myasthenia Gravis crisis. The emergency treatment consisted of two ampules of prostigmine methylsulfate of a strength of 1:2000, and 5cc of coramine. Within a period of eight or ten minutes, the patient experienced a generalized convulsive seizure which lasted some five minutes and required 4 men to hold him on the bed. Prostigmine, by needle, was continued for three weeks, and then 15mg. tablets every six hours. Thiamin hydrochloride was given three times each day, intramuscularly, as well as other fractions of the B complex. In one years time, he had been weaned off prostigmine. Although given only two weeks to live by the physicians at the medical centre the day prior to our first visit, this individual lived a normal life for 18 years. His death was due to a cerebral accident.

Female, white, with diagnosis (August 1967), Polyneuritis. Began with pain and burning of legs associted with jerking. Ran high fever 10 days. Paralysis started on left side along with weakness of hands, soon followed with complete paralysis lower extremities. Seen first time 7/5/69. Paralysis and weakness as described. Started on medication by mouth and intramuscular injections. Several months later, began intravenous schedule. In approximately 16 months, was able to move right leg. Upper extremities returned to normal. On 6/10/72, began to move left foot. Patient now able to walk approximately 50 yards with knee braces and walker. Does all the cooking for family of four, as well as sewing clothes for herself and two daughters. (I can personally vouch for her ability as a cook.) April 1973, she was able to go without a back brace that was previously necessary for her to use to even get out of bed. One marvels at her ability to pedal a stationary bicycle contraption made for her by her husband so that she might exercise her legs. Our diagnosis in this case is Transverse Myelitis. (200 grams ascorbic acid given I.V., in divided doses, would have saved this patient from paralysis.) She has also received 300mg ribonucleic acid four times each week.
Female, white, who developed weakness in extremities around June 25, 1961. Sensory examination revealed hypalgesia over medial aspect of right foot and calf. Motor examination revealed a partial foot drop on the right, with rather marked weakness and inversion, eversion, and dorsiflexion of right foot. Reflexes upper extremities 3-4 plus. Abdominal reflexes absent. Knee jerks were 3-4 plus with patellar clonus. Right ankle jerk was 4 plus and the left, 3 plus. Bilateral, sustained, ankle clonus. Babinskis brisk.

Later examined and hospitalized at a nearby medical centre where Medrol was tried. She was sent home with a diagnosis of Multiple Sclerosis, superimposed by a viral meningoencephalitis. Blurring of vision was established as due to a left six-nerve paralysis. She came home to a wheelchair provided she lived. Seen in our office one month later, we concurred with the impression of Multple Sclerosis. Our treatment schedule became operative. It has been a long journey since June 1961, but the results have been phenomenal. This individual has been returned to full activities, and as a gesture of gratitude, comes to my office to serve in the capacity of an office assistant several days each week. She does, however, still maintain her treatment schedule. Whether this is necessary or not, I follow the advice of another patient who has been continuing modified treatment for 22 years: Why stop when you feel so good?

Male, white, 28 years. Seen first time 2/26/72. History of numbness in lower extremities with loss of muscle control from waist down. This started approximately 2 years before this visit. Difficulty with bladder control at times. Seen by several neurologists at a nearby medical centre who failed to make a diagnosis other than to say he had a central Nervous System Pathology. Babnskis, Gordon and Oppenheim signs were all positive, and ankle jerks were 4 plus. Ankle clonus was bilateral and sustained on right. He demonstrated a right foot drop. We entertained a diagnosis of Multiple Sclerosis. Treatment was not started since he had an appointment to be examined at a nearby Veterans Hospital clinic. We advised him not to accept ACTH therapy. The following week we did start treatment. After 5 weeks, we did not see the patient again for three weeks, at which time he confessed that he thought that he was well and had stopped treatment. The weakness and other symptoms were again returning. He has been back to gainful employment for the past 12 months. Incidentally, he has been a crack pistol shooter, and he still can hold a steady hand on the gun.

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Neuropathies are a significant cause of morbidity worldwide, mainly from diabetes mellitus, HIV infection and leprosy. Many are treatable with immunosuppression or intravenous immunoglobulin. Tight glycaemic control slows progression of diabetic neuropathy. Even when the underlying disorder is untreatable, making a specific diagnosis and appropriate management to avoid complications and neuropathic pain can be rewarding.

AUTOIMMUNE EPIDEMIC

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