Multiple Sclerosis & Cooling

Eight cryopositive patients with Multiple Sclerosis used Cooling Suits for 40 minutes regularly one or more times daily for a six-week period.

The patients were given repeated motor and mental tests by a PhysioTherapist in order to determine whether they had a continuous beneficial effect of cooling during this period.

Additionally, selected activities of daily living performed in the patient's homes were evaluated and registered according to Assessment of Motor and Process Skills (AMPS).

Six out of eight patients improved in at least one motor test and all patients improved according to AMPS. For one of the patients, who was profoundly handicapped, the effect of cooling was evaluated differently.

Early this year, a study asked the following question: Are there measurable Clinical and Immunological changes occurring when the core temperature of the body was cooled?

Eleven subjects with Relapsing/Remitting MS and Heat-Sensitivity, had a 45 minute session with a cooling (1° drop in body temperature at least) garment and a session with sham cooling in the garment.

Immunological studies, Visual Acuity, Timed Walk, Muscle Strength and Coordination were measured, one hour before and one hour after cooling.

Those action symptoms were improved significantly. The Cytokine types and numbers (known to have an important role in MS exacerbations) were also improved by cooling.

There is a possibility then, that cooling might have benefits beyond symptomatic relief. A further study was able to show that the functional improvements were not due to facilitation of Sensory or Cognitive processes of the CNS.

The mechanism of action for the observed changes remains unknown. We do know that Nerves that have lost their Myelin do not conduct as well when the temperature is raised, so the reverse seems a probability.

Background
Cooling DeMyelinated Nerves can reduce Conduction Block, potentially improving symptoms of MS.

The therapeutic effects of cooling in patients with MS have not been convincingly demonstrated because prior studies were limited by uncontrolled designs, unblinded evaluations, reliance on subjective outcome measures, and small sample sizes.

Objective
To determine the effects of a single acute dose of cooling therapy using objective measures of Neurologic function in a controlled, double-blinded setting, and to determine whether effects are sustained during daily cooling garment use.

Methods
Patients (n = 84) with Definite MS, mild to moderate disability (Expanded Disability Status Scale score < 6.0), and self-reported heat sensitivity were randomized into a multicenter, sham-treatment controlled, double-blind crossover study.

Patients had the MS Functional Composite (MSFC) and measures of Visual Acuity/contrast sensitivity assessed before and after high-dose or low-dose cooling for 1 hour with a liquid cooling garment.

One week later, patients had identical assessments before and after the alternate treatment. Patients were then re-randomized to use the cooling garment 1 hour each day for a month or to have observation only.

They completed self-rated assessments of Fatigue, strength, and Cognition during this time, and underwent another acute cooling session at the end of the period. After 1 week of rest, they had identical assessments during the alternate treatment.

Results
Body temperature declined during both high-dose and low-dose cooling, but high-dose produced a greater reduction (p < 0.0001).

High-dose cooling produced a small improvement in the MSFC (0.076 +/- 0.66, p = 0.007), whereas low-dose cooling produced only a trend toward improvement (0.053 +/- 0.031, p = 0.09), but the difference between conditions was not significant.

Timed gait testing and visual acuity/contrast sensitivity improved in both conditions as well. When patients underwent acute cooling following a month of daily cooling, treatment effects were similar.

Patients reported less Fatigue during the month of daily cooling, concurrently on the Rochester Fatigue Diary and retrospectively on the Modified Fatigue Impact Scale.

Conclusions
Cooling therapy was associated with objectively measurable but modest improvements in Motor and Visual function as well as persistent subjective benefits.