RESOLUTION OF MULTIPLE GASTROINTESTINAL SYMPTOMS, HEADACHES, FATIGUE AND INSOMNIA WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION
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1
Brain, Spine & Sport, United States
Background: A 31 year old female with multiple chronic conditions presented to a private clinic for consultation and evaluation. She presented with a 2 year history of irritable bowel syndrome (IBS). The IBS symptoms included constipation, diarrhea, gas and bloating. The patient presented with a 15 year history of gastroesophageal reflux (GERD). Headache symptoms were persistent over the last year and were occurring daily. Symptoms of insomnia and fatigue were also constant over the last year. In addition, she had a history of esophageal ulcer, gastritis, diverticulosis and asthma. She has consulted with numerous gastroenterologists. Incidently, she was born with the condition of gastroschesis which was surgically corrected as an infant.
Methods: Tilt table testing revealed abnormal increases in heart rate (HR) from supine to standing indicating dysautonomia. Repeated autonomic testing verified a diagnosis of postural orthostatic tachycardia syndrome (POTS) with increases of HR exceeding 30 beats per minute (bpm). Pupillary exam revealed normal response to light with facial muscle activation with stimulation to the right eye. Eye movement exam revealed slow saccades to the right. Leftward optokinetic (OPK) stimulation revealed slowed reflexive movement compared to the right. Finger tapping was slow on the left with a rating of 2 on the United Parkinson’s Disability Rating Scale (UPDRS). Palpation of cervicothoracic spinal segments and musculature revealed aberrant spinal segmental motion, hypertonicity and multiple myofascial trigger points. Palpation of the temporomandibular joint (TMJ) revealed hypertonicity with pain and tenderness on the right. Computerized Dynamic Posturography (CDP) revealed: posterior centers of pressure (pCOP) on firm surface testing with eyes both open and closed. There was a higher stability score with eyes closed compared to eyes open on firm surface testing. Saccadometry revealed a heteroscedastic distribution of 100 saccades in terms of latency, velocity and accuracy with rightward saccades. Velocity was slower with rightward saccades. Hypermetric saccades were present with both rightward and leftward saccades. A program of vestibular and neurological rehabilitation was initiated that included passive canal stimulations, autonomic training on a tilt table, eye movement exercises, gaze stability exercises, spinal manipulative therapy (SMT), extremity manipulation and low level laser therapy (LLLT). The patient was placed on an antiinflammatory diet and supplement protocol which included glutamine, zinc carnosine, various strains of probiotics and vitamin D.
Results: Spinal and TMJ segmental dysfunction reduced along with reduction in muscular hypertonicity findings. Eye movement findings of slow saccades and abnormal OPK findings normalized. Abnormal finger tapping normalized. The patient reported that the two year history of IBS symptoms resolved, claiming “no issues now.” The patient claims the “headaches which were daily are non-existent now.” The insomnia and symptoms of fatigue are resolved. Symptoms of GERD are resolved. Signs of POTS/dysautonomia resolved with normal elevation of HR of 15-20 bpm from supine to standing on tilt table testing.
Conclusions: this author recommends further investigation into neurorehabilitation and clinical nutrition programs in the recovery of patients with chronic gastrointestinal symptoms, headaches, insomnia and fatigue. This includes addressing the role of dysautonomia and its resolution as part of the treatment.
Keywords:
Irritable Bowel Syndrome,
Gastrointestinal Diseases,
POTS,
Postural Orthostatic Tachycardia Syndrome,
dysautonomia,
Gastroesophageal reflux disease,
Headaches,
insomnia,
Fatigue,
saccadometry,
computerized dynamic posturography,
Vestibular Rehabilitation,
Autonomic Nervous System,
Neurorehabilitation,
Spinal manipulative therapy,
Low level laser Therapy,
Clinical Nutrition,
Glutamine,
Probiotics,
Vitamin D,
Gut permeability,
leaky gut
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:
Schiller
D
(2018). RESOLUTION OF MULTIPLE GASTROINTESTINAL SYMPTOMS, HEADACHES, FATIGUE AND INSOMNIA WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00105
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Received:
01 Apr 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. David Schiller, Brain, Spine & Sport, Avon, Connecticut, 06001, United States, drschiller@comcast.net