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Goals of treatment

Goals of treatment

Stage of total Recovery:

Complete recovery from MS without leaving any residual symptoms. This is possible in initially diagnosed patients without having serious symptoms like walking debility or incontinence etc., who are having fewer lesions in brain, where the spine is not affected or not having massive lesions in spinal cord. EDSS 1 – 3.5 (For more info read staging of MS according to PAMS).

Expected results after 3 years PAMS

  1. Improvements in symptoms like walking distance, vision, balance etc.

  2. No decline in physical capability or any neurological functions.

  3. Stopping the progression of the disease.

  4. NO appearance of new symptoms.

  5. MRI – DIS (Dissemination in Space) and DIT (Dissemination in Time) are controlled which means no appearance of new lesions, disappearance of present lesions (in 25% cases) or the lesions become non-active.

Stage of improvement and stability

 

Here patients between EDSS 4-6.00 are considered. Those who are able to walk without help but with difficulties, who needs walking aid and who have problem in balancing, bowel and bladder control, or vision, or fine motoric symptoms, or extreme fatigue, etc. (For more info read staging of MS according to PAMS)

Stabilisation of MS & Improvement of MS symptoms.

Stage of Prevention – Preventing the progression of disease.

Stage of Management  

 

For Patients above EDSS 6.5, progression can be slowed down with continuous medicine/therapy after the treatment.

Duration of treatment

  • The minimum duration of the treatment is 50 - 60 days a year, which has to be repeated for 3 consecutive times.

  • The exact period of treatment could only be ascertained by the Doctor after consultation.

  • In case of advanced stage of MS or rapidly progressive MS, the duration of stay and treatment days will be more.

  • It is also to be noted that the 1st year is the most important treatment time and at times the initial year treatment duration could be more than 60 days which depends on PAMS criteria.

  • If patients are unable to take immediate treatment from the hospital, they can take our herbal medicinal preparations and schedule treatment later.

 

Staging of MS

For the convenience of assessment of patient and administration of treatment we are staging the MS as:

 

  1. According to Ayurvedic Constitution :

    • Grade 1 - Predominantly Vata – Risk groups

    • Grade 2 - Predominantly Pitta, Vata-Pitta – Difficult manage groups

    • Grade 3 - Kapha Pitta – Manageable groups

    • Grade 4 - Predominantly Kapha, Vata-Pitta-Kapha

Check your constitution
https://www.ayurveda.com/pdf/constitution.pdf

  1. According to Symptoms of MS :


 

Symptoms

 

Grade 1

Grade 2

Grade 3

Grade 4

SENSITIVITY

 

 

 

 

Localized area (Ex. In the limbs)

Aware only when you concentrate

Local

Extremities or trunk not continuous.

Continuous, one joint to the other.(ex. Numbness below the knee)

Continuous, whole limb, half of body, face

FATIGUE

 

 

Mild fatigue than during healthy days

Can walk and exercise but needs extra rest

3-4 hours active life

1-2 hours active life

BALANCING

 

 

Rarely instable(ex. while getting up from chair)

Mild but often, can stand on one foot

Unsteady, cannot stand on one foot

Unsteady, cannot stand independently

WALKING

 

0-10% reduction in distance.

No visible gait change.

10-40% reduction in distance.

Mild change of gait.

40-70 % reduction in distance or

Visible changes in gait.

 

70-100% reduction in distance.

A few steps or not able to walk

BLADDER

 

Mild increased frequency, no urgency, no incontinence

Increased frequency -1 in 2 hours, increased urgency – can hold for 10 min, no incontinence

Increased frequency – 1 in less than 1 hour, increased urgency, less than 10 min, had or rarely incontinence

Incontinence often, using diapers

BOWEL

 

Constipated but daily

Constipated – 1 in 2 days

Had incontinence previously

Have incontinence. using diapers

MEMORY

 

Not influencing work in daily life but not efficient as earlier to MS

Affected but could lead normal life

Much affected, but needs help occasionally

Serious lack of memory, loss of continuity in words. Needs continuous help.

DEPRESSION

 

Calm and collected

Got or can get normal with mental support

Had pre MS-depressions

Had medication, continuous depression for 2 years

 

MIND

 

 

A bit anxious about MS, otherwise calm

Rarely getting anxious, fear, anger

Frequent getting anger, fear, anxiety

Constant fear, feeling of anxiety and anger

SPEECH & Swallowing

 

0

0

Mild/rarely

frequent

TREMOR

 

0

 

0

Mild, able to write or do other work in more than 1 year

Whole body tremor, unable to write, less than 1 year


 

  1. According to lesions present :

    • Stage 1 – Recently occurred, few, smaller active or non-active cerebral lesion, more in periventricular region. Absence of spine lesions.

    • Stage 2 – Multiple lesions in the brain, and less than 2 lesions in the spine but not confluent, size of lesion not more than 3 mm.

    • Stage 3 – Moderately increasing multiple lesions in the brain and lesions in the spine that are confluent, size of the lesion 3mm – 6mm.

    • Stage 4 – Fast increasing lesion in brain and spine that are confluent, multiple lesions of size more than 6 mm, with brain volumn reduction and black holes. Lesions in the thalamus, pons, medulla and deep white matter.

 

  1. According to type of MS :

    • Grade 1 – RRMS- cerebral form with less than 4 lesions.

    • Grade 2- PRMS

    • Grade 3- PPMS/SPMS

    • Grade 4 – NMO
       

  2. Other Factors : Relapse

    • Grade 1 – First mild relapse and fast recovery

    • Grade 2 – 2-3 relapse, recovery easier

    • Grade 3 – 4 or more than 4 relapses but some symptoms persist.

    • Grade 4 – frequent relapse with incomplete recovery

       

  3. EDSS

    • Grade 1 - EDSS 1.00-3.00

    • Grade 2 – EDSS 3.5 – 4.5

    • Grade 3 – EDSS 5.00- 6.5

    • Grade 4 – EDSS 7 and above

       

  4. Mental status

    • Grade 1 – Content and happy nature without marked emotional disturbance.

    • Grade 2 – Moderate emotional disturbance related to MS.

    • Grade 3 – Frequent mental disturbance with mood swings, fear, and anxiety. With short duration intake of anti-depressive. Mild change in personality.

    • Grade 4 – Continuous depression and on frequent medications. Noticeable change in personality.


 

  1. Accompanying disorders : the presence of other disorders complicates the healing process of MS

    • Grade 1 – apparently healthy, without any history of other diseases

    • Grade 2 – disease that are not related to neuro, psycho, immune, endocrine disorders.

    • Grade 3 – diseases related to neuro, psycho, immune, endocrine disorders.

    • Grade 4 – developmental childhood anomaly with other long standing or chronic disorders, or diseases under Grade 3.

9. Past medication especially immunosuppressive

  1. Grade 4 - longer period of time after trying all MS medication available

  2. Grade 3 – moderate period of time on many MS medication

  3. Grade 2 – short period of time on a few MS medication

  4. Grade 1 – no major hospitalisation or other MS medication