Evidence-Based Care

We spend a great deal of time continuing our education so we can better serve our patients. We stay up to date with the current medical research regarding new therapies and treatment options. We have a strong understanding of the science and medical research, and we use this approach to create the best treatment options for our patients. Our new Blog is a great way for patients to connect with some of this new research.

Gluten and Neuro-Degenerative Disease

A case of celiac disease mimicking amyotrophic lateral sclerosis.

Turner MR, Chohan G, Quaghebeur G, Greenhall RC, Hadjivassiliou M, Talbot K. Nat Clin Pract Neurol. 2007 Oct;3(10):581-4.

Department of Neurology, John Radcliffe Hospital, Oxford, UK.

BACKGROUND: A 44-year-old male presented to a general neurology clinic with a 6-month history of progressive right-sided spastic hemiparesis without sensory symptoms or signs. The thigh muscle in the affected leg showed signs of wasting. The patient had a remote family history of celiac disease.

INVESTIGATIONS: Neurological examination, neurophysiological studies, brain MRI scan, routine blood tests, duodenal biopsy, cerebrospinal fluid analysis including polymerase chain reaction test for JC virus DNA, serological testing for HIV and for the presence of serum antibodies to endomysium, gliadin and tissue transglutaminase.

DIAGNOSIS: Celiac disease with neurological involvement, mimicking amyotrophic lateral sclerosis.

MANAGEMENT: Strict gluten-free diet.

MRI Scan

1. The patient developed signs/symptoms of ventral horn cell disease, and a complete workup was performed. Numerous diagnostic tests were obtained including the above MRI scan of the brain. You can see the abnormal findings that appear as a lighter shade of gray within the red circles.
2. An MRI was repeated 2 months later that revealed even more extensive changes to the subcortical region of his brain with additional damage.
3. More diagnostics were performed and it was discovered that this patient had celiac disease. The patient started on a gluten-free diet approximately 7 months after the initial onset of his symptoms. MRI "C" was taken after the patient was on a gluten-free diet for 9 months. No other treatment of medication was provided. This repeat MRI shows partial resolution of the initial lesion. Some of his function returned to normal, while other functions had limited improvement because of permanent damage that was done. This patient was followed for another 2.5 years with no evidence of neurological relapse.

Lou Gehrig Loved Wheaties

Lou Gehrig was the first athlete to be pictured on the Wheaties box. Lou Gehrig also died of ALS (amyotrophic lateral sclerosis), which is commonly known as Lou Gehrig’s disease. What if he had a gluten sensitivity?

(D. Kharrizian, 2009)

Balance Disorders and Auditory Therapy

Posturographic Changes Associated With Music Listening

Carrick FR, Oggero E, Pagnacco G. J Altern Complement Med. 2007 Jun;13(5):519-26.

OBJECTIVES: The aim of this study was to ascertain whether listening to music might cause changes in human stability and be useful in fall prevention and rehabilitation. The aim was also to find what percentage of subjects without neurologic signs or symptoms associated with falling had less than ideal stability.

DESIGN: Computer dynamic posturography (CDP) provided stability scores in 266 subjects without a history of falls or vertigo. Subjects were randomized into several different music listening groups and one control group. The music listening groups were given a daily specific music listening task and CDP was obtained 10 minutes, 1 week, and 1 month after the subject's treatment in a blinded fashion.

RESULTS: Tests of postural stability have shown that 73% of 266 subjects without neurologic signs or symptoms were found to have balance abnormalities associated with an increased probability of falling. We have demonstrated positive changes in stability scores in these subjects who underwent a variety of music listening tasks, with the music of Nolwenn Leroy found to be significantly superior to other music tested. CONCLUSIONS: Listening to certain types of music has the potential to change human stability and promote change in the field of fall prevention and rehabilitation with a potential to decrease disability.

This video clip demonstrates a patient with a history of cerebellar stroke. The patient has marked difficulty with balance and coordination in her trunk muscles, which is known as truncal ataxia. The video shows the patient placing her feet together and closing her eyes. Putting her feet together narrows her base of support and closing her eyes decreases visual feedback to her postural and balance system. When the eyes are closed the patient starts to wobble. Upon closing the eyes again the patient wobbles and falls to the right. This is known as a positive Romberg’s sign. The patient is then seated and listens to one track of music from French artist, Nolwenn Leroy. After listening to this track, the Romberg test is repeated and shows marked improvement in the patient’s balance and postural stability. The patient no longer falls to the right and now has a negative Romberg’s sign. The following abstract is from the research study published supporting the use of this music to increase postural stability.

More to come...