Central Pontine Myelinolysis

[gsoh]

My wife, 50, suffered Central Pontine Myelinolysis in August 2000. The second neurologist said the MRI indicated central & extra-pontine, with damages shown to the pons and also Basal Ganglia.



She had Hyponatremia on 1/8/00 (Sodium at 100). The neurologists attributed it to a high blood pressure blood drug called Moduretic and 48 hours of vomiting. She was confirmed CPM, due apparently to the too rapid correction of sodium chloride during the first 35 hours (to 128) following the coma & seizure after Hyponatremia.



Her cognitive abilities were not affected albeit minor behavioral change.



She has improved from assisted standing to self-gait walking (500 meters) over 6 weeks. Able to stand up on her own from a few limited sitting positions. Her right hand is able to hold a small cup of water. Taking a deep breath to hold on is still a difficulty. Rollover on bed is still very difficult. The strongest part of the four limbs at right leg is still having difficulty for coordinated movement.



She was discharged on 23/8/00 and being 24 hours attended in the home.



The neurologist has prescribed Piracetam & Madopar. He is also agreeable for me to give my wife Ginko tablets. He has termed supportive treatment for my wife and cannot give any definite answer to extent, duration of recovery or expected permanent impairment.



From 23/8/00 to 13/9/00 on the day of follow up visit with the neurologist, her legs have improved to self gait walking for 500 meters and the ability to stand up by herself from a few limited sitting position. Her right hand can rise above the head, holding a small plastic cup of water. Her left hand rising is only shoulder height. Holding a deep breath is still not possible. The neurologist attributed the improvement to medication of Madopar (Parkinsonism) & physiotherapy. The neurologist also prescribed Piracetam (Nootropil)for her. Brushing aside any possible effects of acupuncture that she was undergoing everyday since discharge, in conjunction with physiotherapy. He provided the opinion that once the recovery started, though slow, will definitely continue.



I am obviously more interested to know any chances of speeding up the process of re-myelination before it is too late. I started reading about the myelin reformation. Unfortunately, I cannot find any resources that confirm positively the process in adult brain cells. Nor is there any authority to rule out the process or point to the timing of a brain damage like CPM or other brain disorders.



I started giving her Omega-3 oil, colloidal form minerals, Vitamin B6, B12. I read about IgG that may act with adult Oligodendroglia for the re-myelination process. So I give her chewable tablets of colostrums which contained high concentration of Immunoglobulin G. All these, being health food supplements, in my mind, should have minimal side effects.



I also read about the research and trials of Neural Stem Cells. This is apparently too early and the attention seems to be directed towards others type of brain disorders, rather than induced brain disorders.



Any pointers on treatment or speed of recovery, experience of recovery on CPM would be most enlightening.

[CCF Neuro[P] MD, RPS]

Dear gosh:



Sorry to hear about your wife.  Remyelination is a tough area because we do not understand much about the physiology of when, where and under what circumstances it reoccurrs.  We know that in MS there is remyelination.  There is also the migration of neurons and some evidence of proliferation of neurons in the adult brain.  However, there is not much known about the controls or what starts it and what are the limitations of remyelination.  Adult oligodendroglia are capable of limited proliferation and there are some glia stem cells in adult brain.  Again, what controls proliferation and myelination are unknown.  There is no data to suggest that IgG has any effect on oligodendrocyte proliferation, in fact in culture it has absolutely no effect.  Growth factors are the key and beside fibroblast growth factor, platlet derived growth factor undefined astrocyte growth factors, etc we do not know what these are in the brain. The transplantation of oligos have been performed in animals and the transplanted oligos will remyelinate axons.  This has not yet been tried in humans to my knowledge although I know some groups are beginning to study this.



We know that the brain has a limited but definite healing capacity.  The most rapid recovery occurs in the first 6-12 months and then begins to taper off.  The extent depends on the etiology and the extent of the lesion.  Not knowing the details makes me unsure of what to expect in your wife. But it is very encouraging that she has made the strides she has.  I hope it continues.



Sincerely,



CCF Neuro MD

[gsoh]

I also read about an abstract article of research treatment of CPM by therapeutic Plasmapheresis reported in “THE LANCET”. 18 days after the cause of the CPM, I shown this to the Professor of Neurology who seen my wife, as a fourth opinion. The Professor encouraged me to let my wife go through the Plasmapheresis. I declined one day later. Being a layman, not able to get to read the full research report, I still came to the conclusion that Plasmapheresis, if effective, has to be performed very early of CPM setting in. In my case, the first neurologist who treated my wife may have hidden (his own error) by purpose, the CPM. By the time I get to know two weeks later, this type of treatment may not be effective anymore.



I wrote to the administrator of THE LANCET net for access to that full research report but have no luck. Any opinion or knowledge on this aspect of Plasamapheresis will be helpful.