Neurological Question?

[Curt Leatherbee]

This question might be best answered by Dr. Young.

My Mother has had trouble with balance and walking for years, she is 70 years old, she recently had a MRI of the Brain done which showed that she has disturbances of the Mylien covering in the motor control area of the Brain, the Doctor stated that nothing could be done (of course, they always say that). In the meantime she is tripping over her feet and falling a lot, it really worries me.

I was wondering if 4ap might be worth a try?, I know it affects the way Neurological signals are transmitted and I thought maybe it is worth a try?. If so, how do we go about getting her some 4ap, I am a Paraplegic, so I suppose I could get a prescription?

Thanks in advance. Curtis

[Wise Young]

4-AP may help your mother. It is important, however, if she does take it, to make sure that this is under the supervision of a knowledgeable physician. The drug is not an innocuous one and requires physician supervision, particularly in an older person.

Please understand that there are other therapies that are being developed to remyelinate the brain and spinal cord. These include Schwann cell transplants, oligodendroglial precursor transplants, and perhaps even olfactory ensheathing glial transplants.

The finding of areas of demyelination in her brainstem is worrisome. Did her doctor do any additional tests to see about the possibility of multiple sclerosis? Did she have multiple areas of demyelination or are the areas in the brainstem the only one. If she does have multiple sclerosis or a variant of MS, there are a number of therapies that significantly reduce progression and exacerbations.

Wise.

[This message was edited by Wise Young on August 06, 2001 at 02:33 AM.]

[Curt Leatherbee]

I am going to print this and give this to her and I'll find out about the areas of demeylination and get back to you. From what she told me others in the family have had this problem of balance in the past, I am kind of worried about her though. I do not believe that it is MS though, hopefully not.

[Wise Young]

I realized that I had a typographical error in the posting (i.e. "have multiple sclerosis" rather than "not multiple sclerosis") which I have corrected.

Some of the MS therapies that have shown some benefit include several interferon preparations (betaseron) and calpaxone. Experimental remyelination therapies that will be starting clinical trial include M1 (Acorda Therapeutics), porcine neural stem cell transplants (Diacrin), and porcine olfactory ensheathing glia (Alexion). Some other therapies that may be beneficial and that are starting clinical trial include AIT-082 (Neotherapeutics).

[Curt Leatherbee]

She has no other symtoms that go along with MS, plus is it likely a person this old would get MS? I thought it was younger people mostly that got MS between thirty and fourty. But I was thinking maybe Parkinsons disease? although she has no shakes or anything. Her next appointment is not till October with a Neurologist, apparently the one who ordered the MRI is her general doc, I wish she did not have to wait so long to find out what is going on, she is worried. Do you know of any top notch Neurologists here in Rhode island or Boston? I would like to try and find someone who can see her sooner than October and someone I know is good and is up to date on the Current treatments for the problem she is having. Thanks a lot.

[Wise Young]

If it is not too far, I would suggest Steve Waxman at Yale. He is familiar with 4-AP and the chair of neurology at Yale. The reason that I was thinking MS was the MRI finding that suggested demyelination. The symptoms of MS are unpredictable; it is often called the great mimicker. You are right that MS is most often seen in young to middle-age white women but I also know a bunch of men and older African-American women who have the condition.

Steven G. Waxman, M.D., Ph.D.
Professor and Chairman
Dept. of Neurology (LC1-707)
Yale Medical School
333 Cedar Street, Box 3333
New Haven, CT 06510 USA
office: 203-785-4086, 203-937-3802 VAH; fax: 203-785-5694;
email: stephan.waxman@yale.edu

[SCI-Nurse]

First of all she needs an accurate medical diagnosis. Seek a second (or third) opinion until you get a diagnosis. There are several excellent MS programs in the Boston area. Contact your local chapter of the National MS Society for a physician referral there or closer to your home.

Once she has a diagnosis, you may want to see if any of your local hospitals or rehab centers have established a "Falls (prevention) clinic". This is one of the more recent trends in healthcare with our aging population and so many concerns about this high costs in both money and suffering/disability related to falls in the elderly. An interdisciplinary team would evaluate your mother and make recommendations about technique, equipment and environmental changes that would reduce her risk for falls. Medicare generally covers this clinic cost. (KLD)

[Curt Leatherbee]

Really appreciate it, I am kind of worried about her, for years she has kind of shuffled her feet when walking and it has become more and more of a chore, she is even afraid of going down stairs etc. I think the sooner she gets this diagnosed, the better. Then she can get on the proper medication for the problem if there is any availbable for whatever it is.

[Curt Leatherbee]

It seems my mother is not very interested in really following up on this. Her general doc has told her "this a lot more common than you would think" so now she thinks it is a normal thing for a person who is 70 years old and seems to think it runs in the family because my Grandmother was not very sure on her feet and same thing with her mother. Sure sounds like denial to me, but whatever can't force someone to do things. I gave her the Neurogists info in New Haven, but I don't think she is going to contact him. Thanks for the help anyhow Dr. Young and Kld.