Multiple Sclerosis and Cooling, Third Edition
Table of Contents
Introduction: Multiple Sclerosis
Multiple Sclerosis (MS) is the most commonly diagnosed neurological disorder among young adults. MS is characterized by a disruption of nerve impulses traveling from the brain or spinal cord to other parts of the body, along the nerves of the central nervous system (CNS). Researchers believe that once a person acquires MS, his or her immune system malfunctions and damages or destroys the protective layer, known as myelin, in the brain and spinal cord. Myelin can be thought of as the insulation around the body's circuitry. Nerve fibers, called axons, may become damaged as well.
When myelin and/or axons are damaged, nerve impulses "short-circuit" before they can complete their journey. The resulting variety of symptoms may include difficulties with vision, numbness, fatigue, balance, spasticity, bladder and bowel function, cognition, and depression, among others. Many individuals with MS may experience only a few, while others may experience a number of symptoms. For most, these symptoms are temporary, particularly for the first several years following diagnosis. For more information about MS, its symptoms, and treatments available, please contact MSAA at (800) 532-7667, to speak directly to a Helpline consultant or to request additional literature.
Cooling and Multiple Sclerosis
Studies have shown that nerves with damaged myelin are sensitive to changes in temperatures.(1) Researchers note that a rise in temperature may cause a failure in the effective transmission of signals from the brain to the body (nerve conduction), and a reduction in temperature may allow more signals to be transmitted across the damaged nerve.
The idea of cooling individuals with MS to alleviate symptoms is not a new one. Several research programs were conducted during the 1950s using cool baths.(2) These studies and many unconfirmed personal accounts seemed to substantiate the theory that cooling the body may provide temporary symptom relief for people with MS. Unfortunately, cooling practices such as taking cold baths several times a day and sitting close to air-conditioning are often uncomfortable, impractical, and dangerous, due to the body's defense mechanisms of shivering and vasoconstriction. The answer to these problems is found in the technology developed for eliminating the physical stress of extreme heat and cold for astronauts in space.
Space Technology Refines Cooling
The National Aeronautics and Space Administration (NASA) developed space suits to protect astronauts from the hazards of space. A space suit, however, will also trap heat inside the suit. To stabilize an astronaut's body temperature, space suits are equipped with an undergarment containing a network of small tubes held against the body. A chilled liquid is pumped through these tubes, removing the body's heat by heat transfer between the skin and the tubes. These garments are known as liquid-cooled garments (LCG's), but are often referred to as "cool suits." Cool suits are now used in a variety of industrial and military applications.
Known for their expertise with LCG's, NASA scientists continued to refine and adapt this technology for the advancement of biomedical research. These advancements include cooling systems for cancer patients undergoing chemotherapy, children who suffer from HED (insufficient sweat glands), and those
MSAA Advances Cooling Therapy
In 1992, MSAA embarked on a pioneering mission to fund scientific research on the clinical effects of cooling and MS, eventually funding several clinical research studies. This research was conducted at clinics across the nation, including:
Along with these studies, MSAA continued to expand its cooling program by purchasing active cooling systems (or cool suits) for in-home use by people with MS. In addition, special clinical cooling systems were placed in several key MS centers throughout the country.
As MSAA and NASA continued to expand the science of cooling and MS, both agencies realized the need to pool resources and accelerate the goal of bringing symptom relief to thousands of people with MS. On May 23, 1994, officials from MSAA and NASA signed a "Memorandum of Understanding" to establish a framework for cooperative efforts.
This provided a springboard from which many joint endeavors have been completed. These include national workshops, equipment evaluations, and finally, a national clinical research study funded by NASA, in which MSAA staff played a significant role.
The outcome of this study is summarized on page seven of this booklet. Since that time, MSAA continues to be committed to the advancement of research on cooling and MS.
Summary of Clinical Studies on Cooling and MS
In recent years, cooling as a symptomatic therapy for MS has generated significant interest. This is due in part to the availability of liquid-cooled garments and advances in evaluation techniques. The following research studies and summary quotes are examples of the many clinical trials that have involved cooling.
Effect of Cooling on Physical Performance in Multiple Sclerosis
Dr. George Kraft, principal investigator, and Alan Alquist, research scientist, University of Washington MS Clinical & Research Center, Seattle, Washington (completed in 1996).
"Subjectively and objectively, we noticed remarkable gains [for those with] heat-sensitive MS [in their] ability to perform repetitive activities. We believe this may be an important finding for MS patients for it is repetitive motor tasks that elicit extreme local and central fatigue in MS patients."
Enhancement of Cognitive Processing
|"Passive" cooling refers to cooling with no "active" cooling mechanism, such as a separate pump. Passive cooling can be accomplished through a simple transfer of heat by wearing a garment containing a cooling source.
Evaporation garments include bandanas, skullcaps, and vests. These garments are usually soaked in water, rung out, and occasionally chilled in the refrigerator. As the water in the garments evaporates, they provide limited relief from heat, depending on climate conditions. These garments are less effective in areas with high humidity.
Most passive-cooling garments work by placing ice or gel packs into pockets of a vest. This type of system can provide immediate and simple relief from the heat. These vests allow many people with MS to enjoy outside activities that would otherwise be intolerable.
Studies have shown that the immediate loss of cognitive and/or physical function can occur due to an increase in either internal (through exercise) or external (room or outside) temperature. Passive cooling can significantly reduce the impact of these factors by providing a simple cooling mechanism. Passive cooling cannot be viewed as a symptomatic therapy, but can be seen as a valuable preventative tool to help reduce the impact of heat in people with MS.
New Technology and MSAA's Cooling Program
MSAA is continuing its efforts to hasten the development of more effective cooling units. MSAA staff is regularly called upon by manufacturers to provide expert advice and relate client experiences. MSAA continues to evaluate the effectiveness of new cooling equipment as it becomes available.
In keeping with our philosophy of delivering quality client services and programs to individuals with MS, MSAA's Cooling Program offers the free use of active or passive cooling garments and a large range of passive cooling accessories to MSAA clients, based on suit availability and program guidelines. Physicians and clinics may also apply for the free loan of cooling equipment, providing the items are used in free, patient care or research programs.
For more information on MSAA's Cooling Program, please call (800) 532-7667, extension 102. For more details about cooling therapy and research, please call (800) 532-7667, extension 153.
1) Davis F. A. and Jacobson S., Altered thermal sensitivity in injured and demyelinated nerve, Journal Neurosurg Psychiat, 1971, 34, pp. 551-561.
Davis F. A., Axonal conduction studies based on some considerations of temperature effects in multiple sclerosis, Electroencephalog Clin Neurophysiol, 1970, 28, pp. 281-286.
McDonald W.I. andSears T.A., Effect of a demyelinating lesion on conduction in the central nervous system studied in single nerve fibers, Journal Physio. (Lond), 1970, 207, pp. 53-54P.
2) Watson C.W., Effect of lowering of body temperature on the symptoms and signs of multiple sclerosis, New Eng. Journal Med, 1951, 261, pp. 1253-1259.
Boynton, B.L., Garramone P.M., and Buca J.T., Observations on the effects of cool baths for patients with multiple sclerosis, Phys Ther Rev, 1959, 39, pp. 297-299.
List of Suggested Reference Works Regarding Neurohypothermia as a Symptomatic Therapy for MS
Please Note: This is not an inclusive listing, merely the editor's choice. Bold type indicates works of primary importance.
Basic Cooling Theory
Boynton B.L., Garramone P.M., and Buca J., Cool baths as adjunct treatment in patients with multiple sclerosis, Quart Bull (Northwest Univ M School), 1959, 33, p. 6.
Boynton B.L., Garramone P.M., and Buca J.T., Observations on the effects of cool baths for patients with multiple sclerosis, Phys Ther Rev, 1959, 39, pp. 297-299.
Davis F.A. and Jacobson S., Altered thermal sensitivity in injured and demyelinated nerve. Journal Neuro Psychiat, 1971, 34, pp. 551-561.
Davis F.A., Axonal conduction studies based on some considerations of temperature effects in multiple sclerosis, Electroencephalog Clin Neurophysiol, 1970, 28, pp. 281-286.
Harbison J.W., Calabrese V.P., and Edlich R.F., A fatal case of sun exposure in multiple sclerosis patient, The Journal of Emergency Medicine, 1989, 7, pp. 465-467.
McDonald W.I. and Sears T.A., Effect of a demyelinating lesion on conduction in the central nervous system studied in single nerve fibers, Journal Physiol (Lond.), 1970, 207, pp. 53-54P.
Nelson D.A., Jeffreys W.H., and McDowell F., Effects of induced hyperthermia on some neurological diseases, Arch Neurol Psychiatry, 1958, 79, pp. 31-39.
Schauf, C.L., Pencek T.L., Davis F.A., and Rooney M.W., Physiological basis for neuroelectric blocking activity in multiple sclerosis, Neurology, 1981, 31, pp. 1338-1341.
Watson C.W., Effect of lowering of body temperature on the symptoms and signs of multiple sclerosis, New Eng Journal Med, 1951, 261, pp. 1253-1259.
Cooling Therapy in MS
Bassett S. and Lake B., Use of cold applications in the management of spasticity, Phys Therapy Rev, 1958, 38 (5), pp. 333-334.
Beenakker E.A.C., Oparina T.I., Hartgring A., Teelken A., Arutjunyan A.V., and De Keyser J., Cooling Garment Treatment in MS: Clinical Improvement and Decrease in Leukocyte Nitric Oxide (NO) Production, Neurology, 2001, 57, pp. 892-894.
Capello E., Gardella M., Leandri M., et al, Lowering body temperature with a cooling suit as symptomatic treatment for thermosensitive multiple sclerosis patients, Ital Journal Neuro Sci, Nov. 16, 1995, 8, pp. 533-539.
Kinnman J., Anderson U.A., and Kinnman Y., Temporary improvement of motor function in patient with multiple sclerosis after treatment with a cooling suit, Journal Neuro Rehab, 1997, 11, pp. 109-114.
Kinnman J., Anderson U.A., Anderson A., Wetterquist L., and Kinnman Y., Cooling Suit for Multiple Sclerosis: Functional Improvement in Daily Living, Scand Journal Rehab Med, 2000, 33, pp. 20-24.
Kraft G. and Alquist A., Effect of microclimate cooling on physical function in multiple sclerosis, Cooling and Multiple Sclerosis, 1997, 1, pp. 6-9.
Ku Y.E., Montgomery L.D., and Webbon B.W., Hemodynamic and thermal responses to head and neck cooling in men and women, Am Journal Phys Med Rehabil, 1996, 75, pp. 443-450.
Ku Y.E., Montgomery L.D., and Lee H., et al, Physiologic and functional responses of MS patients to body cooling, Am. Journal Phys Med Rehabil, 2000, 13, 8994-9115.
Montgomery L.D., Montgomery R.W., and Ku Y.E., Enhancement of cognitive processing by multiple sclerosis patients using liquid cooling technology: a case study, Submitted in 1998 for publication to Am. Journal Phys Med Rehabil.
Nelson D.A. and McDowell F., The effects of induced hyperthermia on patients with multiple sclerosis, J Neurol Neurosurg Psychiatry, 1959, 79, pp. 31-39.
Pellegrino R.G., Roberts A.J., and Harper-Bennie J., The use of in-home portable conductive cooling units from the study to evaluate the chronic effects of conductive cooling in multiple sclerosis patients, Cooling and Multiple Sclerosis, 1997, 1, pp. 9-10.
Schauf C.L. and Davis F.A., Impulse conduction in multiple sclerosis: a theoretical basis for modification by temperature and pharmacological agents, Journal Neurol Neurosurg Psychiatry, 1974, 37, pp. 152-161.
Schwid S.R., Petrie M.D., Murray R., Leitch J., Bowen J., Alquist A., Pellegrino R.G., Milan M.D., Roberts A., Harper-Bennie J.E., Guisado R., Luna B., Montgomery L., Lamparter R., Ku Y.T., Lee H., Goldwater D., Cutter G., Webbon B., A Randomized Controlled Study of the Acute and Chronic Effects of Cooling Therapy for MS, Neurology, 2003, 60, pp. 1955-1960.