Improving Quality Of Life For People With Chronic Conditions: The Example Of T'ai Chi And Multiple Sclerosis
Husted C, Pham L, Hekking A, Niederman R
Altern Ther Health Med 1999 Sep;5(5):70-4
Univ of California, Center for the Study of Neurodegenerative Disorders, Santa Barbara 93106-5060, USA
PMID# 10484833; UI# 99414474
The greatest needs of people with chronic conditions are long-term care, maximized independence, and improved quality of life.
With conventional medicine becoming increasingly expensive, depersonalized, and unable to adequately meet such needs, many with chronic conditions are seeking health promotion strategies to effectively manage their symptoms.
Objective & Design
An 8-week t'ai chi program was conducted to explore psychosocial and physical benefits for those with Multiple Sclerosis. Nonrandomized, noncontrolled pilot study.
Setting & Patients & Intervention
American College of Traditional Chinese Medicine, San Francisco, Calif. 19 patients with Multiple Sclerosis. Doing T'ai chi.
Main Outcome Measures
Walking Speed (distance = 25 ft), Hamstring Flexibility, and Psychosocial well-being as measured by the Medical Outcomes Study 36-item Short-form Health Survey.
Walking Speed increased by 21% and Hamstring Flexibility increased by 28%. Patients experienced improvements in vitality, social functioning, mental health, and ability to carry out physical and emotional roles.
This pilot program was conducted entirely on a volunteer basis and led to the implementation of several additional T'ai Chi classes for people with Multiple Sclerosis across the United States.
T'ai Chi and other health promotion programs offer help toward achieving the goals of increasing access to services, maximizing independence, and improving quality of life for people with chronic disabling conditions.
MonoClonal AntiBody Treatment Exposes Three Mechanisms Underlying The Clinical Course Of MS
Coles AJ, Wing MG, Molyneux P, Paolillo A, Davie CM, Hale G, Miller D, Waldmann H, Compston A
Ann Neurol 1999 Sep;46(3):296-304
Addenbrooke's Hospital, Univ of Cambridge Neurology Unit, UK
PMID# 10482259; UI# 99409985
The elective treatment of patients with Multiple Sclerosis, using a humanized Anti-Leukocyte (CD52) MonoClonal AntiBody (Campath-1H), has illuminated mechanisms that underlie the clinical course of the disease.
Twenty-seven patients were studied clinically and by Magnetic Resonance Imaging (MRI) before and for 18 months after a single pulse of Campath-1H.
- The first dose of MonoClonal AntiBody was associated with a transient rehearsal of previous symptoms caused by the release of mediators that impede Conduction at previously DeMyelinated sites
- Disease activity persisted for several weeks after treatment but thereafter Radiological markers of Cerebral Inflammation were suppressed for at least 18 months during which there were no new symptoms or signs
- However, about half the patients experienced Progressive Disability and increasing Brain Atrophy, attributable on the basis of MRI Spectroscopy to Axonal Degeneration
- Which correlated with the extent of Cerebral inflammation in the pretreatment phase
These data support the formulation that Inflammation and DeMyelination are responsible for relapses of Multiple Sclerosis
- Inflammatory mediators, but not Tumor Necrosis Factor-, cause symptomatic reactivation of previously DeMyelinated lesions
- Axonal Degeneration, conditioned by prior Inflammation but proceeding despite its suppression, contributes to the Progressive phase of Disability
These results provide evidence supporting the emerging view that treatment in Multiple Sclerosis must be given early in the course, before the consequences of inflammation are irretrievably established.
Cellular and Humoral Immune Responses Against AutoReactive T-Cells in Multiple Sclerosis After T-Cell Vaccination
Hermans G, Denzer U, Lohse A, Raus J, Stinissen P
J AutoImmun 1999 Sep;13(2):233-246
Dr L. Willems-Instituut, Limburgs Universitair Centrum, AutoImmune Disease Unit, UnivCampus, Diepenbeek, Belgium
Myelin Basic Protein (MBP)-reactive T-Cells may play an important role in the AutoImmune PathoGenesis of Multiple Sclerosis (MS).
MBP-reactive T-Cells can be specifically targeted by T-Cell vaccination, a procedure whereby MS patients are immunized with attenuated autologous MBP reactive T-Cells. T-Cell vaccination induces Immune Responses to the vaccine cells together with a depletion of MBP reactive T-Cells.
Forty-nine MS patients were treated with T-Cell vaccination in an extended phase I trial to study the safety, Immune Responses and clinical effects of T-Cell vaccination.
In the present paper the Immune Responses towards the vaccine cells were characterized. Substantial long-term in vitro proliferative responses were observed in all treated patients.
Some patients, immunized with different clones, displayed distinct proliferative reactivity against the various vaccine clones, suggesting unequal Immunogenic properties of these clones.
Reactive TCRalphaB+, CD8+ and CD4+T-Cells, and to a lesser extent, d T-Cells and NK Cells were observed to in vitro stimulation with the vaccine cells.
A small fraction only of CD8+T-Cells expressed CytoLytic and inhibitory anti-clonotypic reactivity against the vaccine cells.
Stimulation with the vaccine clones predominantly induced expression of ProInflammatory Cytokines in these mixed cultures, although one vaccine clone consistently induced production of IL-4.
CD4+T-Cells are the major Cytokine-producing cells in these anti-vaccine lines. We could not detect upregulated AntiBody responses to the vaccine cells in most patients, although a temporary AntiBody response was observed in one patient.
In conclusion, immunization with attenuated AutoReactive T-Cells induces a complex Cellular Response specifically targeted at the vaccine cells, but no AntiBody responses.
These data provide further insights into the mechanisms of T-Cell vaccination and improve our understanding of the complex regulatory networks of AutoReactive T-Cells.
Copyright 1999 Academic Press.