A 23-year-old Female Diagnosed With Celiac Disease And Rheumatoid Arthritis And Suffering From Physical And Emotional Sequelae Is Treated Using A Novel Brain-based And Vestibular Rehabilitative Approach.
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Dr. Shannon Leon Functional Neurology, United States
Background
Current statistics in 2017 estimate that 1 in 133 Americans have celiac disease, and that rheumatoid arthritis affects as much as 1% of the worldwide population. Despite the prevalence of these autoimmune maladies there is still no agreed upon treatment strategy. A 23-year-old female presents to our functional neurology clinic with diagnoses of celiac disease and rheumatoid arthritis with sequelae, subjectively ranked from most to least important, that includes: getting sick often, “high” anxiety, neck pain, bilateral elbow pain, low back pain, lumbar disc bulges, and migraines.
Methods
When addressing a constellation of symptomatology, diagnostic testing and detailed bedside neurological examination are necessary to triangulate locations of lesions within the nervous system. Videonystagmography assessment confirmed resting nystagmus downbeat, square wave jerks alternating right and left, gaze fixation instability was noted with short time constants in the left horizontal, right vertical, and left vertical eye positions, absent right and left vestibulo-ocular reflexes, right eye accommodation in primary position, left ptosis, and left corectasia were observed. Blood pressure seated measured in right 152/112, heart rate 92 beats per minute, and in left 174/110, 89 beats per minute; standing blood pressure in right 152/100, 78 beats per minute, in left 159/100, 79 beats per minute. Neurological examination revealed finger-to-nose hypermetric on the right, alternating hand movements dysdiadochokinetic on the right, Weber’s test lateralizes right, pinwheel decrease sensation right V1 distribution of trigeminal nerve and right upper extremity, vibration sensation decrease in right upper extremity, muscle stretch reflexes 2+ bilateral in upper and lower extremities. Auscultation of the eyes with a stethoscope revealed that left posterior semicircular canal head tilt intermittently discontinues resting downbeat nystagmus, and normal cardiac rhythm was maintained throughout all semicircular canal head tilts. Dynamic posturography reveals deficiencies in right posterior semicircular canal (SCC), right otolith, and left posterior SCC. Based on findings, patient was diagnosed with functional disorders involving, from most to least relevant to symptomatology, left cerebral cortex, left pons, right and left mesencephalon, right cerebellum, left cerebellar cortex (Purkinje cell global disinhibition), right benign paroxysmal positional vertigo (BPPV), right horizontal SCC BPPV, bilateral peripheral vestibular hypofunction, subluxations within the regions of cervical, thoracic, lumbar, and extremities were noted, and disc pathologies at levels C4/5, C5/6, C7/T1, and L5/S1 are present. A brain-based, multimodal treatment plan included was prescribed that included vestibular rehabilitation maneuvers, vestibulo-ocular re-training, specific eye movement therapies, joint manipulation of the spine, extremities, and intervertebral discs, and personalized at-home brain exercise therapies.
Results
The patient was prescribed a treatment plan of one visit per week for four months, sixteen sessions in total. After initial treatment, post-checkup reveals that full sensation of pinwheel and vibration is preserved bilateral in upper extremities, lower extremities, and trigeminal distributions, and seated left blood pressure reads 138/91, 78 beats per minute. At completion of treatment plan, while patient is also currently treating a sinus infection, anxiety is reported “much better,” vestibulo-ocular reflexes are within normal limits bilaterally, there is no gaze fixation instability in the horizontal plane, and patient is motivated to set a new health goal to lose weight. Patient chooses to continue treatments in our office to achieve new daily potentials in quality of life, daily functioning, and disease prevention through lifestyle modification.
Conclusion
Autoimmune-related symptomatology can be alarming to patients due to the seemingly-unrelated, systemic ill effects. Treating physicians should provide complete understanding for the patient as to the intersections of physiology that manifest such clinical presentations. A 23-year-old female presents to our functional neurology clinic with diagnoses of celiac disease and rheumatoid arthritis with sequelae, and sees clinical resolution and improvement in symptomatology using a brain-based, multimodal treatment approach. Further investigation is warranted for interventions involving brain-based therapies for autoimmune diseases.
Keywords:
Celiac Disease,
rheumatoid arthritis (RA),
Brain Based Rehabilitation,
vestibular therapy,
disc pain
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Leon
S,
Case
M and
Langhough
J
(2018). A 23-year-old Female Diagnosed With Celiac Disease And Rheumatoid Arthritis And Suffering From Physical And Emotional Sequelae Is Treated Using A Novel Brain-based And Vestibular Rehabilitative Approach..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00053
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Received:
30 Mar 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Jason Langhough, Dr. Shannon Leon Functional Neurology, Woodbury, NY, 11797, United States, j.langhough@gmail.com