Patient history
A 69-year-old gentleman, smoker, known with hypertension, dyslipidemia, previous ischemic stroke, involving the left cerebral hemisphere, a year ago, developed progressive balance disturbances, with double vision, diagnosed with progressive supranuclear palsy, by independent Neurologist in January, 2024.
MRI of the brain demonstrated the humming-bird sign, together with left parietal lobe atrophy, suggestive of PSP [The presence of the hummingbird sign had a specificity of 99.5% and a positive predictive value of 96.1% for a diagnosis of PSP]
He was commenced on dopaminergic therapy, for 5 months (Sinemet) with minimal improvement.
The Hummingbird Sign, on MRI brain
He was subsequently reviewed in May, 2024, and commenced on Photobiomodulation therapy (PBMT), together with intravenous NAD, and Glutathione therapy.
No further pharmacological agents (Sinemet) were adjusted during the 10 week treatment protocol.
Patient commenced on the above-mentioned therapy with signed consent.
Neurological examination at baseline
Psychomotor slowing noted, in the absence of any aphasia, significant supranuclear gaze palsy, with asymmetrical bradykinesia, right sided predominant, with ataxic gait pattern, and stooped posture, no resting tremor noted, or postural instability noted.
Photobiomodulation treatment protocol
Photobiomodulation device, Bioflex Laser (Low Level Laser, Class IIIb), consisting of red and near infrared light transcranial photobiomodulation therapy, with near infrared laser therapy probe.
Daily treatment sessions, for 10 days, followed by twice a week sessions, until reviewed again in August 2024 (10 weeks from baseline)
Intravenous NAD and Glutathione therapy
Intravenous antioxidant therapy was administered once a week, NAD (250mg), in combination with Glutathione (2G), for the first 3 weeks, then NAD (125mg) and Glutathione (2G), weekly for the duration thereafter.
UPDRS
The Unified Parkinson's Disease Rating Scale (UPDRS) is the most widely applied rating instrument for Parkinson disease (PD).
Score ranges from 0 to 176, with 0 indicating no disability and 17 indicating total disability.
Initial UPDRS Score (June, 2024) 23 (13 % disability)
Follow up UPDRS Score 21 (July, 2024), 19 (August, 2024), and 10 (End of August, 2024), equivalent of 5.6 % disability.
Gait Speed
The speed at which a person walks can be influenced by a number of factors, both voluntary and involuntary, and marks a functional skill that underpins a majority of the tasks that are essential to a person’s ability to function on a daily basis.
Given this, walking speed, which is more commonly referred to as gait speed in the clinical setting, is a metric that is extremely valuable for practitioners when examining aspects of functional mobility in their patients.
Additionally, given its ability to be influenced by multiple body systems (i.e. central nervous system, musculoskeletal system), gait speed is often used as a predictor of overall health and function, especially in older adults.
Gait speed has been considered by some to be a "Vital Sign," much like blood pressure and heart rate, and it's predictive ability has been linked with a myriad of common outcomes including hospitalization, fall risk, cognitive decline, disability, and mortality.
Initial 6m gait speed 5.5 sec
Follow up gait speed, 3.74 sec (End of August, 2024), equivalent of 32 % improvement in gait speed
Neurological examination, at 10 weeks
Patient was noted to be more alert, and attentive, able to mobilize without assistance, with improved posture, and less bradykinesia, improved gait speed noted, with residual supranuclear gaze palsy.
Discussion
Progressive supranuclear palsy (PSP) is a rare neurological disorder that affects body movements, walking and balance, and eye movements. PSP is caused by damage to nerve cells in areas of the brain that control thinking and body movements.
Parkinson-plus syndrome (PPS), also called atypical parkinsonism, refers to a group of neurodegenerative movement disorders that resemble idiopathic Parkinson's disease (PD) with certain distinguishing clinical and pathophysiological features.
PSP is different from Parkinson's disease, although some of their symptoms are similar. PSP typically begins in a person’s mid- to late-60s, later than when Parkinson’s disease symptoms typically develop.
Unlike Parkinson disease, these conditions have a limited response to levodopa with a poor overall prognosis.
The disease usually worsens rapidly and most people with PSP develop severe disability within three to five years of symptom onset. PSP can lead to serious complications such as pneumonia, choking, or head injuries from falls
Current PSP treatment options
There is currently no treatment that effectively stops or slows the progression of PSP, and symptoms usually do not respond well to medications.
Parkinson's disease medications rarely help people with PSP. In some individuals, levodopa can treat the slowness, stiffness, and balance problems associated with PSP, but the effect is usually minimal and short-lasting.
Injections of botulinum toxin into muscles around the eyes can help with PSP-associated eye closing.
Some antidepressant drugs may offer some benefits beyond treating depression, such as pain relief and decreasing drooling.
The patient underwent photobiomodulation and intravenous antioxidant therapy over a period of 10 weeks, with significant improvement with respect to the gait speed, and UPDRS.
His overall gait, coordination and speed improved, suggesting endogenous release of dopamine.
Neuroinflammation plays a key role in the development of PD. Conventional treatment options for PD include medications, surgery, and lifestyle changes.
PBM is a non-invasive treatment that has shown promising results in treating neuroinflammation and improving the symptoms of PD.
Our Experience using PBMT and IV antioxidant therapy, in PD
In our experience, we have seen sustained improvements in patient's motor scores, UPDRS scales, pain, fatigue, as well and gait speed, with PBMT, with a maintenance therapy treatment program.
The changes and improvements are sustained as long as patients are on a long- term maintenance therapy program, as it seems to be neuroprotective, in nature.
Our findings are in agreement with those of previous studies that reported gait improvements in PD patients after Transcranial Photobiomodulation, as well as with other preclinical studies that suggest that Photobiomodulation therapy could be a potential strategy against neurodegenerative diseases.
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